Next year, patient cost sharing for brand-name drugs will be cut in half, and the doughnut hole will be closed completely by 2020.
Marilyn Tavenner, acting administrator at the Centers for Medicare and Medicaid Services, answered questions about how the new benefit will be implemented.
Skin & Allergy News: How many Medicare beneficiaries will fall into the doughnut hole this year? Will they all get checks this summer?
Tavenner: About 8 million Medicare beneficiaries are expected to reach the prescription drug coverage gap that we call the doughnut hole this year. Of those, 4 million will be eligible to get a tax-free, one-time rebate check. The remaining beneficiaries already receive assistance through Medicare Extra Help
Marilyn Tavenner
Beneficiaries who hit this coverage gap do not need to fill out any form, or make any phone call, to receive this benefit under the Affordable Care Act. The one-time $250 rebate checks will be mailed automatically to seniors’ homes from Medicare when they enter the doughnut hole. The first rebate checks were sent in June, and checks will sent each month throughout this year as more beneficiaries enter the doughnut hole.
Skin & Allergy News: Will the $250 rebate have a significant impact on patients’ out-of-pocket drug costs this year?
Tavenner: The $250 rebate is immediate relief that marks the first step in completely eliminating the doughnut hole. This year’s rebate will help put money back in the pockets of seniors who are too often forced to choose between paying for their groceries or for their medications.
Next year, seniors who reach the coverage gap will get a 50% discount on brand-name drugs that will help reduce their costs. In addition, under the new law, actual coverage gap will get smaller and smaller every year, until it completely disappears in 2020.
Skin & Allergy News: Physicians in all specialties spend a lot of time helping patients find affordable medications. How will these changes decrease the burden on doctors?
Tavenner: Physicians are on the front lines in helping seniors obtain medications that are not only successful in treating the patient, but are also affordable. By closing the coverage gap and making care more affordable, Medicare beneficiaries will be able to get the care they need and deserve. And starting next year, patients with Medicare can get free preventive care services like colorectal cancer screening and mammograms. Medicare also will cover an annual physical, where they can work with their physician to develop a personal prevention plan based on current health needs.
Skin & Allergy News: How can physicians help their patients to take advantage of this new benefit?
Tavenner: Doctors can continue to help their patients by educating them about the Affordable Care Act so they can take full advantage of its new benefits. If patients have questions on their rebate checks, they can call 1-800-Medicare or visit www.medicare.gov. And to receive updates on the health reform law as it is implemented, they can visit www.healthreform.gov.
One important note: Along with the additional benefits provided by the Affordable Care Act come increased threats of fraud. That’s precisely why we’re working with the Department of Justice to crack down on scam artists who are trying to procure personal information from Medicare beneficiaries by promising them rebate checks and other benefits under the law. Patients should never give their Medicare ID number to anyone promising benefits or discounts under the new law. For fraud-fighting tips, please visit www.stopmedicarefraud.gov.
Marilyn Tavenner is acting administrator for the Centers for Medicare and Medicaid Services, which administers the Part D Medicare benefit and will be responsible for implementing many elements of the new health reform law. She previously served as secretary of health and human resources for Virginia.