PORTLAND—
Several Maine health groups applauded the agreement reached last weekend by the White House, Senate Finance Committee and the nation’s pharmaceutical research companies to help seniors pay for their prescription medicines during the Medicare Part D coverage gap, also known as the “doughnut hole.”
“This is a huge step toward national health care reform,” said Susan Rowan, Executive Director of the Maine Cancer Foundation. “The commitment to close the coverage gap for affected Part D beneficiaries will be an enormous help to thousands of seniors in Maine who have prescription drug coverage thru Medicare and fall into the coverage gap.”
“This is a truly meaningful step in the right direction toward relieving health care costs,” said Jim Phipps, Executive Director of the Iris Network, which serves thousands of older people in Maine who are visually impaired or blind. “Thousands of Maine Medicare Part D beneficiaries are going to see real savings on their prescription costs thanks to this voluntary agreement.”
Although the Medicare prescription benefit program has been a tremendous success for the vast majority of seniors, the coverage gap has posed a challenge to some. Specifically, pharmaceutical companies will provide a 50 percent discount to most beneficiaries on brand-name medicines covered by a patient’s Part D plan when purchased in the coverage gap.
Additionally, under the agreement the entire negotiated price of the Part D covered medicine purchased in the coverage gap would count toward the beneficiary’s out-of-pocket costs, thus lowering their total out-of-pocket spending. Importantly, the proposal would not require any additional paperwork on the part of the beneficiary nor would an asset test be used for eligibility.
Currently, Medicare beneficiaries fall into the coverage gap after spending $2,700 on prescription medicines, of which Medicare pays 75 percent. With the exception of Part D beneficiaries who qualify for the low-income subsidy, there is no drug coverage after $2,700 until a patient reaches $6,100 in prescription costs, after which Medicare pays 100 percent of a patient’s drug costs.
