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Medicare Drug Program & Medicare News
Medicare Doughnut Hole and Physician Pay Cuts Get
Attention in House Ways and Means
Congressional session
nears end, members try to tie up loose ends
September 21, 2006 Two of the hottest Medicare
discussion topics received attention in the House Ways and Means
Committee yesterday how to plug the drug program "doughnut hole" and
how to make the doctors happy with cuts in their Medicare pay. Democrats
released a report showing the vast majority of those in stand-along drug plans
do not have any coverage when they fall into the doughnut hole.
Republicans were trying to convince physicians to accept quality-of-care
data reporting in exchange for reducing or eliminating their pay cut.
 Many
Medicare Beneficiaries Lack Coverage in Prescription Drug Benefit
'Doughnut Hole,' Report Finds
Eighty-eight percent of Medicare beneficiaries
enrolled in stand-alone drug plans under the Medicare prescription drug
benefit are in plans that do not provide coverage during the so-called
"doughnut hole," according to a report released on Thursday by Democrats
on the
House Ways and
Means Committee, the
AP/Boston Globe
reports (Freking, AP/Boston Globe, 9/21).
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Related Stories |
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Wal-Mart to Price Nearly 300 Generic Drugs at $4 to
Help Seniors in Doughnut Hole
Program starts tomorrow in Tampa, will eventually
be nationwide
 September
21, 2006 With thousands of senior citizens falling into the Medicare
drug program's "doughnut hole," where premiums continue but drug
coverage stops, Wal-Mart has announced a program in Florida to make
nearly 300 generic drugs available for only $4 per prescription for up
to a 30-day supply.
Read
more...
Four Million to be in Medicare Drug Program Doughnut
Hole by End of Month
Survey finds 16%
dropping medications rather than go to generics
September 21, 2006 By the end of this month, four
million Medicare-eligible senior citizens and disabled, averaging seven
prescriptions per month, are estimated to fall into the Medicare Part D
"doughnut hole," a nearly $3,000 coverage gap where their drugs are no
longer paid for by their drug plan. Read more...
Eight of 10 Senior Citizens Satisfied With Medicare
Part D Drug Program
But only 32% report they no longer skip or reduce
prescribed doses
September 15, 2006 -
Read
more...
Medicare Advocates Question CMS Tip Sheet on Drug
Program's Donut Hole
Info sent to 'CMS
Partners' to help explain the coverage gap
August 18, 2006
Read
more...
Hole in Medicare Drug Coverage has Seniors Seeing
Red; Companies Green
Community pharmacists say revenue booming
at top providers of Part D Plans
August 8, 2006
Read more...
Confusion Surrounds Doughnut Hole in Medicare Drug
Program
Three major newspapers find lots of confusion among
seniors
July 31, 2006
Read
more...
Read more
on
Medicare
or
Medicare Drug Program |
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Under the drug benefit, beneficiaries are
responsible for 100% of prescription drug costs between $2,250 and
$5,100. Medicare drug plans generally cover 75% of drug costs after a
$250 deductible up to $2,250, and then 95% of prescription drug costs
beyond $5,100 (Kaiser
Daily Health Policy Report, 8/15).
Beneficiaries can purchase Medicare drug plans that
offer coverage during the doughnut hole, though those plans typically
include higher premiums, the AP/Globe reports.
According to the report, purchasing a plan with
coverage during the doughnut hole would increase average annual costs by
$458 for beneficiaries enrolled in stand-alone plans. The report does
not include data on beneficiaries in Medicare Advantage plans or
low-income beneficiaries who qualify for a special subsidy. The report
does not estimate how many beneficiaries will reach the doughnut hole.
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Newer Story |
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Medicare's Doughnut Hole Gets Even Bigger in 2007,
Reports Medical Rights Center
Asclepios
newsletter says administration brags that the average Part D premium is
going down, but it fails to mention that all other out-of-pocket is
going up
September 22, 2006 There is a storm of concern
over the millions of senior citizens falling into the "doughnut hole" in
Medicare drug plans, which is where seniors continue to pay their
premiums but get no help on buying drugs. If it is bad this year, wait
until next year when the "doughnut hole" gets even bigger, according to
Asclepios, the weekly Medicare consumer advocacy update from the
Medicare Rights Center.
Read
more...
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Comments
Rep. Pete Stark (D-Calif.) said, "As this report shows, the opportunity
to purchase plans that fill the hole is a mirage." He added,
"Beneficiaries are no more able to afford expensive, full-coverage plans
than minimum-wage Americans are able to afford a Mercedes."
According to
CMS
spokesperson Jeff Nelligan, beneficiaries with the lowest incomes do not
have coverage gaps. Nelligan said only a small percentage of
beneficiaries will have to pay out of pocket during the doughnut hole
because of state assistance programs and no-cost medications from
pharmaceutical companies' assistance programs (AP/Boston Globe, 9/21).
The report is available
online.
Note: You must have Adobe Acrobat Reader to view the report.
Lawmakers Push AMA To Support Linking
Medicare Payments, Quality Measures
House Ways and Means
Subcommittee on
Health Chair Nancy Johnson (R-Conn.) on Wednesday met with
physician groups to discuss legislation that would stop a 5.1% reduction
in Medicare physician reimbursements that is scheduled to take effect
Jan. 1, 2007, CQ Today reports.
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AMA Turns Up the Heat to Get Congress to Stop
Medicare Pay Cut
Physicians group issues survey again saying care
for seniors threatened
 September 8, 2006 The American Medical
Association turned up the heat yesterday to press Congress to take
action to stop the planned cut in their payments from Medicare, as it
has in past years. They issued a news release targeting senior citizens
saying a survey it commissioned has found 86 percent of Americans are
concerned that seniors access to health care will be hurt if the cuts
go through. The Bush administration "is showing no sign that it wants to
hold off the cuts," and aides to congressional leaders have indicated
that no action is likely to take place, according to the daily report by
KaiserNet.org. (See AMA news release below news report.)
Read more...
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Physician sources familiar with the discussions
said Johnson proposed a 1% reimbursement increase for all doctors in
2007, with an additional 1.5% increase later in the year for physicians
who agree to report quality-of-care data to the government.
According to one source, Johnson proposed "a
longer-term solution to the Medicare physician payment formula in the
out-years." Sources said the
American Medical
Association likely would support the 1% and 1.5% increases,
CQ Today reports.
According to CQ Today, Johnson's proposal "sought a
middle ground" among House Ways and Means Committee Chair Bill Thomas
(R-Calif.),
House Energy and
Commerce Committee Chair Joe Barton (R-Texas) and physician
groups (Reichard, CQ Today, 9/20).
Last week, AMA rejected an offer by Thomas that
would have blocked the 5.1% reduction and increased reimbursements by
between 2.5% and 2.8% in June 2007 for doctors who agreed to report
quality-of-care data to the government (Kaiser
Daily Health Policy Report, 9/15).
Session Ending
Jill Kozeny, a spokesperson for
Senate Finance
Committee Chair Chuck Grassley (R-Iowa), said Grassley
expects Congress to act on legislation regarding the reimbursement
reduction "before the end of the session," which concludes next week.
Kozeny said, "In the longer term, [Grassley] wants
to help achieve a permanent solution to the problems with the payment
formula for doctors." She added, "Stabilizing physician payments would
help alleviate concerns about access to care. He also wants to see
movement toward a system where doctors report quality measures" (Japsen,
Chicago Tribune,
9/21).
AMA Board Chair Cecil Wilson in a statement
Wednesday said, "We are extremely appreciative of the efforts of
chairmen Barton, Grassley and Thomas to stop the Medicare physician
payment cuts that threaten to undermine the physician foundation of
Medicare" (CQ Today, 9/20).
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