Medicare’s drug coverage gap shrinks by Ricardo Alonso-Zaldivar
WASHINGTON - Medicare’s pre- scription coverage gap is getting noticeably smaller and easier to manage this year for millions of older and disabled people with high drug costs.
The “doughnut hole,” an anxiety- inducing catch in an otherwise pop- ular benefit, will shrink about 40 percent for those unlucky enough to land in it, according to new Medicare figures provided in response to a request from The Associated Press.
The average beneficiary who falls into the coverage gap would have spent $1,504 this year on prescrip- tions. But thanks to discounts and other provisions in President Barack Obama’s health care overhaul law, that cost fell to $901, according to Medicare’s Office of the Actuary,
which handles economic estimates. A50 percent discount that the law secured from pharmaceutical com- panies on brand name drugs yielded an average savings of $581. Medicare also picked up more of the cost of generic drugs, saving an additional $22.
The estimates are averages, so some Medicare recipients may do worse and others better. Also, it’s still unclear if the discounts will start to overcome seniors’ deep unease about the law.
Concern over cutting Medicare to expand coverage for the uninsured helped push older voters toward Republicans in the 2010 congres- sional elections. Obama and the Democrats have been trying to woo them back ever since.
For people with high drug expen- ditures, the 50 percent discount offers real savings,” said Tricia
Neuman, director of Medicare poli- cy for the nonpartisan Kaiser Family Foundation. “It’s certainly more helpful than no coverage at all, which is what they had previously.” More than 2 million beneficiaries already have gotten some help, dis- counts that have gone largely to middle-class seniors, because the poor are covered in the gap at tax- payer expense.
For retired elementary school teacher Carolyn Friedman, it meant she didn’t need a loan to pay for drugs that keep her epilepsy under control.
What a change for the better,” said Friedman, 71, of Sunrise, Fla. “This year it was easier to pay my bills, whereas last year I had to bor- row money to pay for my medica- tions when I was in the doughnut hole.”
One of her brand-name anti-
seizure drugs cost about $370 in the gap last year, and the other about $270. This year Friedman paid about $150 and $130, respectively, for a month’s supply.
Medicare covers about 47 million older and disabled people, and about 9 in 10 have some kind of prescrip- tion plan. Most rely on the drug ben- efit, also known as Part D, which is delivered through private insurance plans.
Beneficiaries have until Dec. 7 to change their drug plans for 2012. Consumer advocates recommend that seniors check their coverage during open enrollment to see if their current choice remains the best for next year. Many families start the process around the Thanksgiving holiday.
The coverage gap, a money-sav- ing idea from a previous Congress, never has been popular.
It starts after an individual benefi- ciary and his or her drug plan have spent a total of $2,840 on medica- tions for the year. Seniors are then on their own for the next $3,600. Once total spending reaches about $6,440, Medicare’s catastrophic coverage kicks in and beneficiaries pay only a token amount. Most peo- ple do not spend enough in the doughnut hole to qualify for cata- strophic coverage.
Although few private insurance plans still cap the amount they spend on medications, Medicare’s hole-in-the-middle approach is highly unusual.
The Republican-led Congress that passed the drug benefit under President George W. Bush was try- ing to balance coverage and costs, as many conservatives fretted about creating a new unfunded entitle- ment.
Presidential Advisory Council on HIV/AIDS: World AIDS Day statement
Special to the NNPAfrom the Black AIDS Institute
The 2011 theme for World AIDS Day is “Getting to Zero.”
Presidential Advisory Council on HIV/AIDS commends the Obama Administration on its leadership and investment in the domestic and glob- al AIDS epidemics and for maintain- ing the previous administration’s commitment to prioritize global HIV/AIDS prevention, care and treatment. Not only has the United States’ leadership saved the lives of millions, American-funded research has identified interventions that, if effectively implemented, hold the promise of ending the AIDS pandem- ic in our lifetime. We respectfully urge the President and his Administration to make a bold announcement on World AIDS Day about these important scientific advances and the potential they bring toward achieving zero new infec- tions, zero AIDS-related deaths and zero discrimination - and to commit the resources necessary to make this promise a reality. We stand ready to publicly support the President’s lead- ership and commitment to several realistic actions: 1.
An announcement on World
AIDS Day 2011 that science has made it possible for us to begin to end the AIDS pandemic, and that we as a nation are committed to this goal. 2. Based on research establishing
that AIDS treatment is also HIV pre- vention, a commitment to scale up AIDS treatment to cover six million people by 2013 along with other evi- dence-based, combination prevention interventions through the President’s Emergency Plan for AIDS Relief (PEPFAR). 3. Achallenge to donor and affect- ed countries to increase investments in the response to HIV/AIDS and to join the United States in a “step up” effort to scale-up high-impact efforts- from condom distribution to anti- retroviral treatment access-that can greatly reduce both deaths and new infections. 4. A pledge to move forward on ending the AIDS epidemic in the United States and to address dispari- ties, including the disproportionate impact of HIV on Black Americans, by continuing to implement the National HIV/AIDS Strategy (NHAS) with a commitment of resources for HIV prevention, care, treatment, housing and other support services to meet the NHAS targets, and to forcefully defend full imple-
mentation of the Affordable Care Act, including the federal commitment to the Medicaid program, with its potential to greatly enhance preven- tion and treatment of HIV. 5. Acommitment to defend glob- al health budgets including a bold commitment to fund PEPFAR, the administration’s multi-year Global Fund to Fight AIDS, Tuberculosis and Malaria pledge, and domestic HIV research, prevention, care and housing programs in appropriations and debt negotiations in fiscal year (FY) 2012 and beyond. 6. A call for new investments in research coupled with public-health driven research and development incentive mechanisms and policies to make new tools and technologies available that will help bring an end to the AIDS crisis.
Leadership on these important ini- tiatives must be grounded in a human-rights based approach that responds to the prevention, care and treatment needs of all people, includ- ing key affected populations such as women and girls, children, men who have sex with men, transgender per- sons, sex workers and injection drug users. It is our sincere belief that the end of AIDS is within our grasp and that we can get to zero. By fully
Chicago Defender • ChicagoDefender.com
• November 30-December 6, 2011 17
implementing the tools that United States-funded research has brought us, we could radically change the course of this epidemic in our life-
time. We urge President Obama to seize this moment of opportunity and publicly declare his support for and commitment to this goal.
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