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Generics doughnuts only: Lack of brand-name drug options for Part D beneficiaries

Case Management Weekly, April 4, 2007

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More prescription drug plans will offer some kind of doughnut hole or gap coverage in 2007 than in 2006, but the coverage they provide may not help every beneficiary, according to The Los Angeles Times.

Due to costs, most major private health insurers have decided to drop plans that include coverage for brand-name prescription drugs during the doughnut hole period. Many beneficiaries, such as those with multiple sclerosis or rheumatoid arthritis, must take brand-name drugs because there are no generic alternatives.

Las Vegas-based Sierra Health Services was the only large company to offer comprehensive brand-name medications for beneficiaries in exchange for higher premiums, but the company recently switched back to only generic options after suffering significant financial losses, The Times reports.

Currently, there are 11 states in which no plans will offer brand-name drugs during the doughnut hole period.

Source: The Los Angeles Times; California Healthline

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