Does Obamacare Close the “Doughnut Hole” in Medicare’s Prescription Drug Coverage [Medicare Part D]? – YES
General Reference (not clearly pro or con)
The Patient Protection and Affordable Care Act, Section 3301, “Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans,” page 344, signed into law on Mar. 23, 2010, available at the Library of Congress website, states:
“The Secretary shall establish a Medicare coverage gap discount program (in this section referred to as the ‘program’) by not later than July 1, 2010. Under the program, the Secretary shall enter into agreements described in subsection (b) with manufacturers and provide for the performance of the duties described in subsection (c)(1). The Secretary shall establish a model agreement for use under the program by not later than April 1, 2010, in consultation with manufacturers, and allow for comment on such model agreement.”
Mar. 23, 2010 - Patient Protection and Affordable Care Act (HR 3590)
PRO (yes)
Pro
Ron Pollack, JD, Families USA Executive Director, wrote in a Sep. 6, 2012 article “Why Obamacare Is Good for Seniors and America: Families USA,” available at the Santa Monica Mirror website:
“Like a bad dream, however, the doughnut hole is going to fade away. That terrible gap, where seniors have to pay 100 percent of the cost of their prescription drugs until the other side is reached, is getting smaller every year. By 2020, the doughnut hole would have grown to $6,000 a year; instead, under the Affordable Care Act, by 2020, the doughnut hole will be gone and seniors will only have to pay their copayments. The fact that something so bad is being eliminated is real reform.”
Pro
The US Department of Health & Human Services wrote in its Aug. 20, 2012 press release “People with Medicare Save More Than $4.1 Billion on Prescription Drugs,” available online at www.hhs.gov:
“The health care law includes benefits to make Medicare prescription drug coverage more affordable. In 2010, anyone with Medicare who hit the prescription drug donut hole received a $250 rebate. In 2011, people with Medicare who hit the donut hole began receiving a 50 percent discount on covered brand-name drugs and a discount on generic drugs. These discounts and Medicare coverage gradually increase until 2020 when the donut hole is fully closed.”
Pro
Peter Ubel, MD, Professor of Business and Public Policy at Duke University, wrote in a June 27, 2012 article “Obamacare and Donut Holes Why Donut Holes Raise Cholesterol More Than Donuts,” available at the Psychology Today website:
“If you thought donuts were bad for your health, consider donut holes. Specifically, the donut hole sitting smack in the middle of Medicare Part D, the program helping senior citizens pay for their medications. The donut hole is a gap in coverage causing people, once they’ve received a certain level of financial support for their prescriptions, to have to go it alone for a while, bearing all their medication costs until they’ve spent so much money that a higher level of financial support kicks in.
According to a study in the June 5th issue of the Annals of Internal Medicine… once patients reach the donut hole, they understandably look for ways to save money on their medications. Pain relievers? Patients aren’t likely to scrimp on those pills. After all, no pill, no pain relief. Medications for heart burn? Same basic idea. Daily symptoms are there to remind people of the value of these medicines. Blood pressure and cholesterol pills, on the other hand, are very easy medications to forego. No one feels any different when their cholesterol rises thirty points.
Obamacare, if it remains the law of the land tomorrow, will put an end to the donut hole. It will provide more continuous coverage of Medicare recipients’ prescription costs. This is good news for those of us interested in helping patients prevent things like heart attacks, which these blood pressure and cholesterol pills do well.”
Pro
The Kaiser Family Foundation wrote in its issue brief “Summary of Key Changes to Medicare in 2010 Health Reform Law” on www.kff.org (accessed Sep. 6, 2012):
“The Patient Protection and Affordable Care Act:
• Gradually phases in coverage in the Medicare Part D drug benefit coverage gap, or ‘doughnut hole.’ In 2010, Part D enrollees with any spending in the coverage gap will receive a $250 rebate. Beginning in 2011, enrollees with spending in the coverage gap will receive a 50 percent discount on brand-name drugs, provided by the pharmaceutical industry. The law phases in Medicare coverage in the gap for generic drugs beginning in 2011, and for brand-name drugs beginning in 2013. By 2020, Part D enrollees will be responsible for 25 percent of the cost of both brands and generics in the gap, down from 100 percent in 2010.”
CON (no)
Con
[Editor’s Note: Based upon a neutral reading of the Patient Protection and Affordable Care Act and bi-partisan third party analysis, this question seems to have a clear and obvious Pro (yes) answer, and ProCon.org has therefore presented the responses in a single column with no opposing perspective.]
