Medicare’s Part D Doughnut Hole Has Closed! Mostly. Sorta.

Medicare’s Part D Doughnut Hole Has Closed! Mostly. Sorta.

Some have gone through considerable contortions to avoid rising costs.

Joel Lieberman, 76, a retired judge in Wellington, Fla., spends about $1,000 a year on seven drugs, mostly generic, for cardiac and thyroid conditions.

But he also takes Xarelto, a pricey brand-name blood-thinner. At roughly $1,400 for a three-month supply at his local pharmacy, in past years the cost would have dropped him into the doughnut hole.

“I have found a way around it,” he said. For several years, he bought the drug from Canada at significant savings. Once he could no longer arrange that, he began ordering Xarelto from Israel, where a company charges him $698 for a year’s supply, including shipping.

He feels lucky to be able to pay that sum. “What about those people out there who end up taking their pills three times a week instead of every day because they can’t afford them?” he asked.

It’s hardly a hypothetical question. Last year, Kaiser surveys showed that nearly a quarter of people over 65 struggled to pay for medications. Because of costs, 29 percent didn’t take drugs as directed, either not filling prescriptions, skipping or reducing doses, or substituting over the counter products.

Those polls also show broad public support for Congressional action to reduce prescription drug costs. At minimum, a bill passed by the House in December and one reported out of the Senate Finance Committee in July, plus the Trump administration’s proposed 2020 budget, would all cap out-of-pocket spending for Part D.

The House bill also authorizes the Department of Health and Human Services to negotiate prices with drug makers (as the Department of Veterans Affairs does) for both Medicare and private insurers. The original Part D legislation specifically prohibited that.

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