Editorial: A gap in coverage

Tuesday, Sept. 26, 2006 | 7:21 a.m.

Millions of older Americans are falling into Medicare's "doughnut hole" this month as the program's temporary gap in their prescription drug coverage takes hold and forces them to pay full price for their medicines.

The so-called "doughnut hole" is built into the new Medicare Part D drug plan that took effect in January. Medicare is the federally funded health care program for people age 65 and older. The new drug benefit calls for suspending federal subsidies of a participant's prescriptions once his or her coverage has hit $2,250. The coverage resumes only after participants have spent $3,600 of their own money buying prescriptions.

According to a story by The Washington Post on Monday, about 3 million of the 23 million Americans on Medicare will hit the gap this year. And that coverage lapse only adds to the confusion that abounded when the Bush administration announced the new program, which included dozens of prescription plans from which seniors were to choose.

A spokesman for the Medicare Rights Center, a nonprofit group that helps seniors understand the system, told the Post that "many people feel blindsided" by the program that this month is forcing many to choose between spending hundreds of dollars they haven't budgeted or going without their medicines. One retired school lunchroom worker told the Post that her prescriptions that usually cost $58 for a three-month supply this month will run $1,294. As a result, she is going to forego one of her treatments for breast cancer and try to obtain free samples of eye drops for her glaucoma.

This plan has been bad medicine from the beginning. Pharmaceutical companies significantly raised the prices of some of the most popular maintenance drugs just months after the plan went into effect, and Medicare costs are rising to an unsustainable level. But increasing the financial burden for older Americans while drug companies make out on top is not the solution.