Medicare coverage gap "exaggerated"

A report in the USA Today newspaper has reopened the debate about the impact of the coverage gap in the Medicare Part D prescrption drug benefit, especially with mid-term elections coming up in November. USA Today, quoting a report published in June by PricewaterhouseCoopers, the global managment consulting firm, stated that "an estimated 3.4 million people will have drug expenses that push them into the coverage gap, when they must pay the full cost of prescriptions." The figure does not, however, take into account new state initiatives to provide assistance to low-income households, such as the one recently enacted in Pennsylvania (Marketletter July 17).

The coverage gap, known as the "donut hole" (Marketletters passim), begins when drug expenses total $2,250, including the amount paid by insurance up to $3,600. With reports that some Medicare beneficiaries have reached the gap, media coverage is emerging of patients having to make out-of-pocket payments, or rely on help from family and charities. Drug firms are castigated for, in some cases, suspending or ending aid for low-income patients, such as patient assistance programs, which they argue duplicates the benefit provided by Medicare Part D.

"Donut Hole Day" is September 22