Medical News Today

Doughnut Hole In Medicare Rx Coverage Could Have Political Implications In Congressional Elections

Medical News Today — Monday, July 31, 2006

Medicare beneficiaries with high drug costs "increasingly" are entering the gap in Medicare prescription drug coverage known as the doughnut hole, and experts say the issue could have political implications for the congressional elections in November, USA Today reports (Wolf, USA Today, 7/27). Under the doughnut hole provision of the Medicare prescription drug benefit, beneficiaries are responsible for 100% of total prescription drug costs between $2,250 and $5,100. Medicare then covers 95% of prescription drug costs beyond $5,100. Estimates vary on how many beneficiaries will reach the doughnut hole this year. According to a report released earlier this month by the advocacy groups Institute for America's Future and New Jersey Citizen Action, seven million beneficiaries will be affected by the doughnut hole this year (Kaiser Daily Health Policy Report, 7/13). A study by PricewaterhouseCoopers estimates 3.4 million beneficiaries will reach the coverage gap this year. According to USA Today, "[m]any people with expensive medical conditions such as AIDS, cancer and multiple sclerosis have reached the gap already," while "others, such as those with diabetes and mental illness, are entering it now or will soon." Nancy Ordover of Gay Men's Health Crisis said the doughnut hole is "starting to have a deterrent effect" as some beneficiaries with HIV/AIDS interrupt their treatment regimens because of cost. Kim Calder of the National Multiple Sclerosis Society said many beneficiaries with MS were "very shocked" when drug makers ended assistance programs for treatments after the new coverage began.

Democrats estimate that Medicare beneficiaries with average drug costs will reach the doughnut hole on Sept. 22, six weeks before the November elections, meaning Republicans who supported the program "risk bad publicity" before the election, according to USA Today. "Some like to say that under the Medicare prescription plan, the pharmaceutical companies got the doughnut and the seniors got the hole," Sen. Byron Dorgan (D-N.D.) said. A USA Today/Gallup Poll in April found that voters by a 2-1 margin were more likely to support members of Congress who voted for the 2003 Medicare law. CMS Administrator Mark McClellan said most beneficiaries will see their drug costs decrease under the drug benefit, adding that "the typical beneficiary is not going to have any doughnut hole" (Wolf, USA Today, 7/26).

Broadcast Coverage
CBS' "Evening News" on Wednesday reported on the coverage gap. The segment includes comments from Sen. Bill Nelson (D-Fla.) and Medicare beneficiaries (Andrews, "Evening News," CBS, 7/26). A transcript of the segment is available online. The complete segment is available online in RealPlayer.

NPR's "Morning Edition" on Tuesday reported on the Medicare Prescription Drug Lifeline Act, which Sens. Olympia Snowe (R-Maine) and Ron Wyden (D-Ore.) introduced last week as a method of closing the coverage gap. The segment includes comments from CMS Administrator Mark McClellan; Rep. Jan Schakowsky (D-Ill.); and Medicare beneficiaries who testified about their experiences with gaps in prescription drug coverage before Congress (Silberner, "Morning Edition," NPR, 7/25). The complete segment is available online in RealPlayer.

"Reprinted with permission from You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report is published for, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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