When Are Doughnut Holes a Bad Thing?

A recent article in The Wall Street Journal titled Some Seniors Quit Taking Medicine When Medicare Doughnut Hole Hits discussed the affects on seniors of current Medicare drug coverage, or lack thereof.

You might be asking, "What does Medicare have to do with doughnut notes?" Well, Medicare beneficiaries receive prescription drug coverage up to $2400. However, after their costs for drugs exceed that amount, beneficiaries must pay for their prescription drugs out of their own pockets. There is not coverage again through Medicare until they've spent another $3850 for drugs. This gap is called the doughnut hole.

Many seniors are grappling with how to handle the way this gap in coverage affects their daily medications. Some pharmacies offer discounts to seniors on generic drugs, allowing them to fill some of their prescriptions during this gap interval for $5.00 per month. However, quite a few drugs don't fit in this category.

After a 40-year habit of smoking 3 packs of cigarettes per day, my mother developed deep vein thrombosis and had pulmonary embolism. Luckily, she survived; over 30% of individuals who experience PEs die. She quit smoking cold turkey while she was in the hospital; it's not like they gave her a choice. She was on oxygen 24 hours a day. To help with the withdrawal as well as her postdischarge recovery, her doctor prescribed Wellbutrin. She has been taking it twice-daily now for over 7 years. For her, it works well. She's never wanted to smoke again and it helps with depression as well. Unfortunately, there have been times that she has been switch to generics because of her healthcare coverage in order to save money. For her, the generics don't seem to be as effective; there are reports in the literature that this is true for other patients as well. Last year, my father retired and now my parents have Medicare prescription drug coverage and my mother's in the doughnut hole. She keeps threatening to stop taking the Wellbutrin because of the cost. Not good. It's a medication that she really needs. I keep encouraging her to continue taking it and help her out with the costs as much as I can. However, she's tempted to stop taking the medication altogether.

Many other seniors are facing the same dilemma. How beneficial is healthcare coverage which doesn't provide sufficient support for sick individuals to receive treatment on an ongoing basis?