February 28, 2007

Medicare Prescription Drug Coverage GapNavigating the “Doughnut Hole” With Patients

Author Affiliations

Author Affiliations: Schools of Medicine (Drs Berkowitz, Gerstenblith, and Anderson) and Public Health (Dr Anderson), Johns Hopkins University, Baltimore, Md.

JAMA. 2007;297(8):868-870. doi:10.1001/jama.297.8.868

Mrs Smith is one of more than 22 million Medicare beneficiaries who enrolled in the Medicare Part D prescription drug benefit in 2006.1 She was happy finally to receive some prescription drug coverage, but when she visited the pharmacy in October, she was shocked to discover she had reached a gap in her prescription drug plan, the so-called doughnut hole. For the remainder of 2006, she was responsible for 100% of her drug expenditures until she spent $3600 in out-of-pocket fees. It was estimated that between 3 million2 and 7 million3 Medicare beneficiaries would enter the “doughnut hole” with Mrs Smith in 2006 and it is likely that a similar number or more will in 2007. Because coverage including the doughnut hole differs from other types of prescription drug coverage, this patient will once again confront difficult clinical and financial decisions. Careful planning at the outset and throughout 2007 will be essential.

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