Who gets credit for the Doughnut Hole?

[Guest guest]

Politicians often claim credit for some legislative or

regulatory work they've done -

Ted Kennedy for universal healthcare, Fortney " Pete " Stark

for Stark I, Stark II and Stark III etc. They will often

proudly cite this in their campaigns. I wonder if any

will claim credit for being the originator of the " Doughnut Hole "

in Medicare Part D? I think we should research how the

Doughnut Hole came about and give " credit " to whoever it was

that thunk it up.

[Guest guest]

From CBS’s 60 Minutes reporting on

Medicare Part D:

http://www.cbsnews.com/stories/2007/03/29/60minutes/main2625305.shtml

“The unorthodox roll call on one of the most expensive bills ever

placed before the House of Representatives began in the middle of the night,

long after most people in Washington

had switched off C-SPAN and gone to sleep.

The only witnesses were congressional staffers, hundreds of lobbyists, and U.S.

representatives, like Dan Burton, R-Ind., and Walter , R-N.C.

" The pharmaceutical lobbyists wrote the bill, " says . " The

bill was over 1,000 pages. And it got to the members of the House that morning,

and we voted for it at about 3 a.m. in the morning, " remembers .

“When

the prescription drug bill finally passed shortly before dawn, in the longest

roll call in the history of the House of Representatives, much of the credit

went to former Congressman Tauzin, R-La., who steered it through the

house.

" It's just a messy process, " Tauzin says. " I mean, the old adage

about if you like sausage or laws, you should not watch either one of them

being made is true. It's a messy process. "

Tauzin says that the voting machines were open for three hours " because

the vote wasn't finished. "

As for arms being twisted? " People were being talked to, " he says.

And of Walter ' comment that it was the " ugliest night " he had

" ever seen in politics in 22 years? "

" Well, he's a young member, " counters Tauzin with a laugh. " Had

he been around for 25 years, he'd have seen some uglier nights.”

___

After getting Medicare

Part D passed, “ Tauzin was named president and chief executive

officer of the Pharmaceutical Research and Manufacturers of America (PhRMA) in

January 2005.”*

* http://www.phrma.org/about_billy/

From:

[mailto: ] On

Behalf Of alcald3000

Sent: Thursday, September 18, 2008

5:30 PM

To:

Subject:

Who gets credit for the " Doughnut Hole " ?

Politicians often claim credit for some legislative or

regulatory work they've done -

Ted Kennedy for universal healthcare, Fortney " Pete " Stark

for Stark I, Stark II and Stark III etc. They will often

proudly cite this in their campaigns. I wonder if any

will claim credit for being the originator of the " Doughnut Hole "

in Medicare Part D? I think we should research how the

Doughnut Hole came about and give " credit " to whoever it was

that thunk it up.

[Guest guest]

Had to learn about the DH...

http://www.kff.org/medicare/medicare082108nr.cfm

The "Doughnut Hole"The standard Part D benefit in 2008 has a $275 deductible and 25 percent coinsurance up to an initial coverage limit of $2,510 in total drug costs, followed by a coverage gap -- the so-called “doughnut hole” -- where enrollees pay all of their next $3,216 in drug costs. After reaching that limit, beneficiaries pay 5 percent of any additional drug costs. For 2007, these amounts were somewhat lower.

http://arthritis.about.com/od/medicare/a/doughnuthole.htm

What Is The Medicare Doughnut Hole?

Medicare Part D enrollees pay a co-payment amount for their prescription drugs as determined by their specific plan. For standard plans, enrollees pay their co-payment until their total drug cost reaches $2250. In the initial coverage phase, the enrollee pays a co-pay amount and the drug plan pays the rest of a discounted drug price. The total drug cost is the co-pay amount paid by the enrollee plus the amount paid by the Medicare Part D drug plan.

After $2250 in total drug costs is reached, there is a gap in coverage (the "doughnut hole") and the enrollee must pay the full cost for their prescription drugs until they have paid $3600 out-of-pocket expense. (It has been erroneously reported that the $3600 out-of-pocket expense is in addition to what has been paid out-of-pocket towards the initial $2250. Actually, what has been paid out-of-pocket during the initial coverage phase also counts towards the $3600.)

After total true out-of-pocket (TrOOP) expense equals $3600, enrollees reach "catastrophic coverage" and their cost per drug drops to a small co-pay (usually $2 or $5) or 5% co-insurance, whichever is greater. During the period enrollees are in the coverage gap or doughnut hole, they must still pay their monthly premium.

Do All Plans Have A Doughnut Hole?

Some plans charged a higher monthly premium so as to provide more coverage during the gap which occurs in many plans. When deciding which Medicare Part D prescription drug plan to choose, enrollees have to consider:

Is there an annual deductible?

What is the monthly premium?

What drugs does the plan cover (formulary drugs)?

Are your usual maintenance drugs available as generic drugs or are they covered at a higher tier cost for brand-name drugs?

Is the pharmacy you use in the network of available pharmacies for that plan?

What is the initial coverage, annual coverage gap, and catastophic protection for that specific plan?

Is additional assistance available because of low or limited income?

How Does Medicare Explain The Doughnut Hole?

"If you have high drug costs, you may consider which plans offer additional coverage until you spend $3,600 out-of-pocket. In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription costs. This is called the coverage gap. This "gap" in coverage is generally above $2,250 in total drug costs until you spend $3,600 out-of-pocket. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug costs after a certain limit, you would still pay less for your prescriptions than you would without this drug coverage", according to Medicare.gov.

http://news.yahoo.com/s/hsn/20080822/hl_hsn/34millionseniorshitmedicaredoughnuthole

3.4 Million Seniors Hit Medicare 'Doughnut Hole'

THURSDAY, Aug. 21 (HealthDay News) -- In 2007, about 3.4 million Americans enrolled in the Medicare Part D drug plan reached a gap in their prescription coverage known as the "doughnut hole," leading some of them to stop taking prescribed drugs, says a Kaiser Family Foundation study released Thursday.

The analysis of data found that 26 percent of Part D enrollees who filled any prescriptions in 2007 reached the coverage gap. This includes 22 percent who were stuck in the gap for the remainder of the year and 4 percent who eventually received catastrophic coverage.

snip-snip

Locke, MD

-----Original Message-----From: [mailto: ] On Behalf Of alcald3000Sent: Thursday, September 18, 2008 6:30 PMTo: Subject: Who gets credit for the "Doughnut Hole"?Politicians often claim credit for some legislative or regulatory work they've done - Ted Kennedy for universal healthcare, Fortney "Pete" Stark for Stark I, Stark II and Stark III etc. They will often proudly cite this in their campaigns. I wonder if any will claim credit for being the originator of the "Doughnut Hole"in Medicare Part D? I think we should research how the Doughnut Hole came about and give "credit" to whoever it was that thunk it up.------------------------------------

[Guest guest]