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3.4 million Medicare beneficiaries face drug coverage gap

Physician Practice Advisor, August 16, 2006

Roughly 3.4 million Medicare beneficiaries enrolled in Part D prescription drug coverage, or about 8% of total enrollees, will fall into the plan's "doughnut hole" this year, according to an article in the San Francisco Chronicle. The term refers to a gap in coverage that requires beneficiaries with expenses of more than $2,250 to pay 100% out of pocket before coverage resumes at the $5,100 level.

Faced with high monthly prescription drug costs after hitting the hole, some beneficiaries attempt to cut drug expenses by asking their physicians to prescribe only medications that are absolutely necessary or switching to cheaper versions of drugs.

Beneficiaries who are covered through an employer as well as low-income beneficiaries who qualify for subsidies or dual coverage through both Medicare and Medicaid are shielded from the doughnut hole gap in coverage.

Click here to read the San Francisco Chronicle article.

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