More patients fall into a hole in drug benefit
By Richard Wolf, USA TODAY

WASHINGTON — Seniors and disabled people who have chronic health problems are increasingly entering a gap in Medicare's prescription-drug coverage and finding that they could have to pay thousands of dollars out of pocket. That's already creating a political issue for the fall elections.

An estimated 3.4 million people will have drug expenses that push them into the coverage gap, when they must pay the full cost of prescriptions. The gap, which Congress calls the "doughnut hole," begins when drug expenses total $2,250, including the amount paid by insurance. It continues until a beneficiary has spent $3,600, an amount that will increase in future years.

David Madison, 67, of Lakewood, Colo., was diagnosed with pancreatic cancer in May and fell into the coverage gap this month. One prescription eats up 20% of his $34,000 annual income. "I really don't know where the money's going to come from," he told a Democratic Senate panel last week.

Democrats, aiming to capitalize on the coverage gap, calculate that Medicare beneficiaries with average drug costs will reach it Sept. 22. Their "Doughnut Hole Day" is six weeks before fall elections, when control of Congress is at stake.

"People with diabetes, heart conditions, hypertension and mental disorders may all be hitting the doughnut hole starting now and heading into the election season," says Lindsey Spindle of Avalere Health, a consulting firm.

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