No Donut Hole, But Drug Costs Still Bite
By the Kaiser Family Foundation – March 29, 2019
The 2006 introduction of the Medicare prescription drug benefit was a boon for seniors, but the coverage had weak spots. One was the so-called donut hole – the gap beneficiaries fell into after they accumulated a few thousand dollars in drug expenses and were on the hook for the full cost of their medications. Another was the lack of an annual cap on drug spending. Legislative changes have gradually closed the donut hole so that, this year, beneficiaries no longer face a coverage gap. But there’s no limit for prescription medications in Part D. With the cost of specialty drugs increasing, some Medicare beneficiaries could owe thousands of dollars in out-of-pocket drug costs every year for a single drug. Recent proposals by the administration would address the long-standing problem by imposing a spending cap. But it’s unclear whether any of these proposals will gain a foothold.