Vast Majority of Senior Citizens Do Not Understand
Donut Hole in Medicare Drug Program
Medco offers free guide - What's
Your Gap? Three simple steps to make the most of your Medicare Part D
coverage and delay the Coverage Gap
Nov. 18, 2008 If you are still confused about the
coverage gap or donut hole in the Medicare Part D drug program,
dont feel dumb or alone. Nearly two-thirds of senior citizens covered
by the program dont understand it, although, it is a key part of the
program and can lead to devastating unexpected drug costs.
A new national poll titled "What's Your Gap?
Seniors Struggling with the Medicare Coverage Gap," has found that even
though it has been three years since the introduction of the Medicare
Part D program, and with 56 percent of the eligible population enrolled
in the program, more than one in four beneficiaries either don't
understand the Coverage Gap at all, or simply don't know what the
Coverage Gap is.
And in spite of the lack of knowledge, nearly
one-third of survey respondents have not looked for information on the
Coverage Gap to better understand it.
"Seniors are in the dark about the Coverage Gap,"
says Dr. Richard Dupee, president of the Massachusetts Geriatric Society
and chief of geriatrics at Tufts Medical Center. "Without knowing how
the Coverage Gap works, it's simply impossible to take steps to push off
or prevent it."
To address this issue, Medco Health Solutions,
Inc., the company that financed the survey, unveiled today a multi-level
initiative aimed at educating retirees about the Coverage Gap, and what
steps they can take to stave off or even prevent them from falling into
the "doughnut hole."
About Donut Hole
In 2008, once Medicare enrollees spend
a total of more than $2,510 on prescription drugs in the initial
phase of coverage, they enter the Coverage Gap (donut hole) and
become responsible for the full cost of their medications. In
2009, the Coverage Gap shifts to total drug costs exceeding
$2,700.
The program, "What's Your Gap?" provides retirees
with information about prescription drug savings opportunities, where to
look for hidden savings, and clarifies many misconceptions about the
Coverage Gap. For example, Part D beneficiaries can save up to 38
percent and delay entering the Coverage Gap by an average of two and a
half months by choosing both generics and mail order.
As part of the initiative, Medco has developed a
free consumer's guide called "What's Your Gap? Three simple steps to
make the most of your Medicare Part D coverage and delay the Coverage
Gap."
The free guide presents easy-to-understand
information on savings tools that are largely unknown or underutilized
by beneficiaries and how to track your drug costs against the Coverage
Gap.
The guide is available free to consumers in a
downloadable version at
http://www.whatsyourgap.com/, or by sending a postcard requesting
the guide to "What's Your Gap?", PO Box 8007 Parsippany, NJ 07054-8007.
The poll, a national survey of 1,000 Medicare Part
D program participants conducted for Medco Health Solutions, Inc. (NYSE:
MHS) by Directive Analytics, is one of the first national polls to
attempt to uncover some of the underlying reasons that so many
beneficiaries end up in the "doughnut hole." Key findings include:
Gap Hits Those with Chronic Diseases: Among
respondents who are already in the Coverage Gap in 2008, more than three
out of four regularly take medications to treat more than one chronic
condition; among respondents, 43 percent indicated they had reached the
Coverage Gap before June of 2008.
Missing Out on Savings: Nearly 28 percent of
survey respondents have not used any lower-cost options to reduce their
prescription price tag to delay entering the gap. Furthermore, fewer
than one in four (23 percent) enrollees have discussed ways to reduce
their prescription drugs costs with their physicians. Only 19 percent of
respondents indicated they have used a mail-order pharmacy to reduce
their drug costs.
In 2008, once Medicare enrollees spend a total of
more than $2,510 on prescription drugs in the initial phase of coverage,
they enter the Coverage Gap and become responsible for the full cost of
their medications. In 2009, the Coverage Gap shifts to total drug costs
exceeding $2,700.
Beneficiaries Don't Know What Costs Count Toward
the Gap
According to the survey, one of the root causes of
confusion is that Medicare beneficiaries simply don't know what parts of
a prescription's price count towards the Coverage Gap. Only one-quarter
of enrollees polled correctly stated that the total cost of a drug ?
both their out-of-pocket cost and the health plan's portion of the drug
price ? count towards the Coverage Gap.
"It's one of the great Medicare myths ? that only
copays or out-of-pocket costs count towards the doughnut hole," says Dr.
Dupee. "This misunderstanding gives many seniors a false sense of
security that the Coverage Gap is months away, when in reality, it could
hit them with their next refill."
Bridging the Communication Gap
Recognizing the significance of educating enrollees
about the specifics of the Coverage Gap, Medco has implemented an
integrated Coverage Gap communications program that alerts its
Prescription Drug Plan (PDP) members and specific health plan
beneficiaries through mailings and outbound phone calls of their
proximity to the Gap long before they reach it.
Additionally, any time one of these members
contacts a customer service representative for any reason, that member
can be provided with a real-time Coverage Gap status update. To promote
increased use of generics in order to help members delay entry into the
Coverage Gap, Medco also offers members prescription forms that they can
bring to their physician or will contact the doctor on their behalf to
discuss generic alternatives that can lower the patient's medication
costs.
About Medco (company statement)
Medco Health Solutions, Inc. (NYSE: MHS) is the
nation's leading pharmacy benefit manager based on its 2007 total net
revenues of more than $44 billion. Medco's prescription drug benefit
programs, covering approximately one-in-five Americans, are designed to
drive down the cost of pharmacy health care for private and public
employers, health plans, labor unions and government agencies of all
sizes, for individuals served by the Medicare Part D Prescription Drug
Program, and those served by Medco's specialty pharmacy segment, Accredo
Health Group.
Medco, the world's most advanced pharmacyฎ, is positioned
to serve the unique needs of patients with chronic and complex
conditions through its Medco Therapeutic Resource Centersฎ, including
its enhanced diabetes pharmacy care practice through the Liberty
acquisition. Medco is the highest-ranked independent pharmacy benefit
manager on the 2008 Fortune 100 list. On the Net:
http://www.medcohealth.com/.
Nov. 18, 2008 If you are still confused about the
coverage gap or donut hole in the Medicare Part D drug program,
dont feel dumb or alone. Nearly two-thirds of senior citizens covered
by the program dont understand it, although, it is a key part of the
program and can lead to devastating unexpected drug costs.
