THE DONUT HOLE IS NOT GOOD FOR YOUR HEALTH

          WITH BENEFITS LIKE THIS WHO NEEDS INSURANCE?

I realized the other day that I was up to 14 pills a day. And two of them are in the top 5 best sellers. Fortunately, I thought, its a good thing I got into a good supplemental drug plan to supplement what Medicare doesn't pay out.

Good except, as I have discovereed, no plan is perfect.

 Besides paying a monthly premium of $260.00  re the supplemental insurance plus the $34.00 dollar deductible for medicare each month the copays on three of my drugs has risen to $120.00 per month.

Still, I thought, up to yesterday at the pharmacy things could be much worse. I didn't realize how right I was.

 As the clerk handed me two of the monthly supplies of Lipitur and Nexium I jokingly said when are they going to raise the prices for a change? Expecting to pay my customary $60.00 copay for a one month supply of each drug I was shocked to hear that the cost this month was $145.00 for each drug.

Are you kidding? How can the copay increase almost 5 times for each drug since last month? Please check this out as someone has obviously made a big mistake. The clerk made a call to someone who apparently said the charges were accurate. I nearly shouted now I understand why there is a health crisis in this country. So what's the deal?

I called up my supplemental insurance company and was informed about my having reached a plateau referred to as the "donut hole." Now, in truth I have heard about this donut hole thing but I never thought it would affect me personally. After all I only have a Ph.D.

 THE DONUT HOLE FACTS

Then I did some research to discover to my horror the following article written in 2006: "

Millions face a `doughnut hole' lapse in Medicare coverage                 May-19-06 11

By Tony Pugh
Knight Ridder Newspapers

WASHINGTON - With its troubled launch and frantic final enrollment drive now history, the Medicare prescription-drug program is bracing for what could be its most significant public-relations hurdle yet. 

In coming months, millions of older Americans and people with disabilities will face a lapse in coverage known as the "doughnut hole" once their annual drug spending hits $2,250. At that point, Medicare drug plans stop paying for medications and require members to absorb another $3,600 in out-of-pocket costs before coverage resumes. And even while the plans aren't paying for their drugs, participants must continue to pay their monthly premiums."

So now it was clear that I have fallen into the donut hole. Now what?

 First of all I cancelled the present order. Next I did some research on line checking out some potential alternative choices? Canada? Discount drugs? No, I thought, call my Doctor first. Amazingly he was quite empathic suggesting I try a cheaper drug like over the counter Prilosec as a substitute for Nexium for the next two months at which time the new year starts over with a fresh start.

Ok - that makes since. But what about the other two drugs?

Now I understand why this so called cost saving donut hole idea is probably going to be a disaster. If I had to I would have to pay the extra increase for the drugs. But what happens to many millions of people who are unable to bear even a small increase for their drugs. And since some of the drugs for major diseases cost hundreds of dollars full price they will most probably stop taking the drugs for at least a couple of months resulting in what potentially negative effects?

I would love to hear responses from all of you who are personally affected by this donut hole. My bet is I am hardly alone in my outrage. And if I am right over the long pull the gap in continuity is likely to produce in many millions of people additional distress that is quite likely to require even additional medication for them pushing the cost crisis even higher than it already is.

Perhaps the one good unintended consequence is that the Republicans who obviously have backed the biggest benefactors of the donut hole  - the drug companies and the politicians - will have to soon account for their short sighted legislation as the worst of it coincides with the pending Presidential election. It couldn't be happening to a nicer group of legislators.

If the results of this fiasco are as bad as I think they are going to be the Republicans can look forward to getting about 7 votes of all those people receiving medicare who have fallen into the donut hole like me. The seven are likely to be related to the CEOs of the major drug companies.

Conclusion: With benefits like this why am I buying insurance?