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Drug Rebates On The Way

May 31, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Los Angeles Times, 5.28.2010

Senior citizens who hit the so-called doughnut hole in Medicare’s drug benefit will begin getting $250 rebate checks in two weeks, the Obama administration announced Thursday — providing one of the first tangible benefits of the recently enacted healthcare law.

The rebates, designed in part to bolster support for the controversial law, are the first steps in a decade-long phase-out of the unpopular gap in Medicare Part D drug coverage.

Seniors now enrolled in a Medicare Part D plan pay 25% of the cost of their prescription drugs until the total bill reaches $2,830. At that point, enrollees must pay the full cost of their prescriptions until their total out-of-pocket spending reaches $4,550. Catastrophic coverage then kicks in and enrollees pay 5% of drug costs for the rest of the year.

Department of Health and Human Services officials said Thursday that the first 80,000 seniors who hit that coverage gap, or “doughnut hole,” will be sent checks on June 10, five days before the deadline.

Checks will then go out monthly until the end of the year as more seniors fall into the gap. Health and Human Services Secretary Kathleen Sebelius said Thursday that the department estimated slightly more than 4 million seniors would ultimately get rebates.

“Seniors do not have to do anything to get this check. They don’t have to sign anything. They don’t have to apply for it,” Sebelius said, warning recipients not to be fooled by scam artists seeking personal information by claiming it is necessary to process rebates.

Starting in 2011, the rebate will be replaced by a discount. Seniors whose expenses fall within the doughnut hole will qualify for a 50% discount on drugs. That will be gradually phased up to a 75% discount in 2020, effectively eliminating the coverage gap.

Thursday’s announcement comes as the Obama administration works to highlight benefits of the new healthcare law in the face of persistent public wariness.

Since President Obama signed the law in March, administration officials have secured commitments from insurance companies to immediately begin offering parents who buy their own insurance the option of including their adult children under 26. Employers who provide coverage may choose to make the option available, but it is not mandatory until October.

The administration is also working with states to create new high-risk pools this summer to allow people who have been denied coverage because of preexisting medical conditions to get insurance. However, there are questions about whether there is enough money to do this.

The new healthcare law’s biggest changes — including the creation of regulated insurance markets, the requirement that everyone have health insurance, and the ban on insurance companies denying coverage to sick people — do not go into effect until 2014.

Prices Rising For Brand-Name Drugs In Coverage Gap

March 18, 2010 By: Nadia Category: Medicine Advice, Medtipster, Prescription News, Prescription Savings

Medtipster Source:  The Henry J. Kaiser Family Foundation – www.kff.org
Medicare Part D 2010 Data Spotlight: Prices for Brand-Name Drugs in the Coverage Gap
This analysis finds prices for some commonly used brand-name drugs rising in 2010 for beneficiaries who reach the coverage gap (or “doughnut hole”), with increases since 2006 far exceeding the growth in inflation.

The Part D benefit’s coverage gap generally requires enrollees to pay the full cost of their drugs after their total drug spending exceeds their initial coverage limit ($2,830 in 2010) until they reach the threshold for receiving catastrophic coverage ($6,440 in 2010).  In 2007, an estimated 3.4 million Part D enrollees reached the coverage gap.

Using data posted on the government’s Medicare.gov website, the analysis looks at prices for commonly used brand-name drugs without a generic substitute for enrollees in stand-alone prescription drug plans.  The prices reflect the amount that enrollees would pay for a 30-day supply after they reach the coverage gap and before catastrophic coverage begins.  

The spotlight is one in a series analyzing key aspects of the Medicare Part D drug plans that will be available to beneficiaries in 2010. These spotlights were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation.

Find generic equivalants and alternatives for commonly used brand-name drugs at www.medtipster.com.
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