The dreaded “donut hole.” Pharmacists deal with this every day at this time of year. Despondent patients with a spooked light in their eyes. They have just been told that the drug they have been paying $30 a month for has gone to $173. They are in the donut hole.

Medicare Part D was written with the consultation of insurance companies and the drug companies. It was ostensibly meant to provide care for Medicare patients. In actuality, it pads the bank accounts of the insurance companies and Big Pharma.
Medicare Part D plans pay until the patient’s total value hits $2,510. Then the donut hole. The patient pays 100%  until they have spent $3,000. At that point coverage returns. I can’t imagine how they came up with this.

The bad news from a Kaiser Family Foundation study: 64% of all Alzheimer’s patients go into the hole; 51% of diabetics; 45% using antidepressants.

Sobering figures when you ask the question, “How do they pay for their medications?”

Many of them don’t. They quit taking the medication. They take it only every other day. Cut doses in half. This, my friends, is a disaster. It is a national embarrassment.  You can bet that physicians and pharmacists did not write the Medicare Modernization laws.

What can you do?  Write for the least expensive of your choice of drugs. Ask your patients to bring in the books that their insurance companies mail to them every January. There will be a complete listing of the drugs that they will pay for.  This is another embarrassment. The insurance company telling you what you can write.

There is a catch 22. If there was no donut hole, the chance of overutilization skyrockets. Later on that.