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Lost In The Donut Hole

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There’s not too much disagreement that the federal government’s implementation of the Medicare Part D drug prescription program has run the gamut from fiasco to disaster.

Indications are that the initial serious difficulties are starting to get straightened out but not before causing mass confusion among seniors and many reported incidents of Medicare beneficiaries not being able to get their drug prescriptions filled at all when the program went into effect.

The seeds of this mess probably were planted in the design of the program when Congress cobbled it together in a way that only Congress can.

I remember thinking that one almost had to be a math major with skills in advanced algebra or even calculus in order to figure out how much would be coming out of pocket and how much of the tab the government would pick up.

Then of course there was the notorious donut. Beneficiaries were pretty much covered until their expenses hit $2,250 a year. Once expenses went past that, there was no coverage until another $3,600 was spent out of pocket, at which point coverage resumed.

This “gap” in coverage, as the government terms it (otherwise known as the “donut” to everyone else), presumably was constructed to make the entire program affordable. While on the one hand it’s easy to see how this could cause rampant confusion, on the other hand it’s just one other hole to get lost in. First, there was Alice getting lost down the rabbit hole; then light getting lost in a black hole; and now seniors getting lost in a donut hole.

And that was not the only place they got lost. With an unexpectedly large number of insurers vying for their business and with each one offering a different variation, the choices available to seniors were overwhelming.

They had to sort through many plans, comparing what a plan would offer to whatever medications they currently were taking. Many seniors may have developed a familiarity with formularies over the years, but many have not. Then there is weighing generics against brand-name prescription drugs.

It’s easy to see why initially many seniors felt like this huge expansion of the Medicare program–the biggest actually since its inception in the mid-1960s–was hardly a benefit at all.

Things got so bad in January that some states had to declare emergencies because scads of seniors could not get their badly needed prescriptions filled. This was literally a matter of life and death for some of the most vulnerable segments of the population across the country.

Interestingly, the insurance companies that are participating in the program have come in for relatively little flack. Most people are attributing the woes in getting off the ground to the inefficiency and incompetence of the government, not the insurers. What unaccustomed sweet relief!

Just recently Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, which is overseeing (if that’s the right word) the Part D rollout, said the situation was getting better. So much better in fact that lower than expected costs have reduced the projected government outlays by some $130 billion. That much and the program’s only a month old! Surrealism had nothing on this.

Now, some senators are starting to talk about standardizing the offerings ? la Medigap. Sounds like a plan, gentlemen, but why don’t you take a breather before stirring the batter any more?

Steve Piontek



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