Guest Editorial |

Guest Editorial

After six months’ personal experience with Medicare’s Drug Plan D, I would best sum up its primary operation as "Medicare giveth (benefits), then taketh them away." I was one of the first to sign up, effective Jan. 1, 2006. The monthly premium for the plan was $30. I also liked the statement that there was no annual deductible (I neglected to note its modifying phrase "this year.")

So for the first six months, I loved the plan. For the four most expensive drugs I regularly used, I paid only $28 for a month’s supply for each, including Zoloft, Singulair, Zocor and Advair, compared on average of $130 for each of the brand-named drugs.

The rude awakening occurred in the form of a letter from the AARP Medicare Rx Plan Explanation of Benefits, dated June 15, stating that I had spent $385 in co-payments; that my AARP Medicare Rx Plan had paid $1,476, this figure representing the total that counts towards my initial coverage. The killer statement read as follows: "You still have to spend $3,214 out of pocket before you would be eligible for so-called "catastrophic benefits and costs."

This gap in coverage between initial and catastrophic coverage is also known as the doughnut hole and these are the most hateful words in a dictionary or glossary, for during this period of time the individual is paying through the nose, i.e., out of pocket. Once the individual becomes eligible for the catastrophic coverage, the manual of information states that generally the patient will pay the greater of five percent of his drug cost or a co-pay of $2 to $5 for each of his covered drugs.

I soon learned my new costs for a new Advair inhaler when I requested a refill was close to the original cost of over $150. (Evidently no generic form of Advair exists at this time.)When it came to Zocor, I was charged close to its original cost for generic Simvastin. I still have not requested renewals of Zoloft or Singulair, but I expect to be charged their original costs and generic forms be substituted. Before Plan D went into effect, everybody knows that generic drugs cost less than their brand names, but suddenly we are being charged brand costs for their generic substitutions. I have no idea what is behind this move, but knowing the greediness of the powerful pharmaceutical lobby, I would guess that it, plus Medicare hierarchy, have banded together to make this decision. I cannot wait to compare my last year’s drug costs with this year’s.

My neighbor decided to live with what drug coverage he had prior to the introduction of the Medicare D coverage, so I also look forward to his comparative figures.

I scanned the Medicare literature primarily for what I wanted to see, i.e. the cost of the new plan and its no-deductible feature. I failed to grasp the consequence of what takes place between the time the original coverage ends until the catastrophic coverage takes effect, namely that we pay the highest costs possible. I hope that when it comes time for me to decide whether to renew plan D or revert to my former drug coverage or an alternate plan, I will be cognizant of my mistakes and ask more questions. When I rechecked the manual, it appears that once my catastrophic coverage goes into effect, generally I would pay the greater of five percent of the drug’s cost or a co-pay of $2 to $5 for each of my covered drugs.

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