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Beneficiaries in Part D gap likely to see "roller coaster" effect

NEWS IN BRIEF — Posted Sept. 19, 2011

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Seven in 10 Medicare beneficiaries reaching the Part D doughnut hole in 2008 hit the federal coverage gap again in 2009, according to a study published by the Kaiser Family Foundation.

"These beneficiaries experience a 'roller coaster' effect, facing dramatically different costs as they move through the different phases of Part D benefit during the year (deductible, initial coverage, the coverage gap and possibly catastrophic coverage) and starting over again in January of each year," the September study said.

Research suggests 3.4 million patients reached the doughnut hole in 2009. Patients hit the gap when they spent $2,700 out of pocket on medications. Catastrophic coverage would begin only when the patient spent $4,350 in out-of-pocket costs on drugs.

Many patients repeatedly hitting the doughnut hole need medicine for chronic conditions, the study said.

More than half of patients taking drugs to treat breast cancer or Alzheimer's disease spent enough to reach the gap.

The health system reform law gradually will eliminate the doughnut hole. In 2011, patients received a 50% discount on brand-name drugs when they hit the coverage gap. Nearly 1.3 million patients had reached the gap by the end of July, according to the Centers for Medicare & Medicaid Services.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2011/09/19/gvbf0919.htm.

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