Implemented in January 2006, Medicare Part D prescription drug benefit has been riddled with problems from the start and falls far short of an adequate prescription drug benefit program promised by the federal government.  Many seniors will experience a large gap in coverage for necessary medications, referred to as the ‘doughnut hole,’ during which beneficiaries pay their monthly premiums for the prescription drug program, while paying the full cost of their medications. 

This is why, this week, I introduced the Medicare Doughnut Hole Elimination Act of 2006, legislation which would allow beneficiaries to count both prescription drugs that the insurance plan covers, called a formulary, and non-formulary drugs towards both a plan’s deductible and towards the Part D ‘doughnut hole.’  Currently, private insurance plans administering the Medicare Part D program have a set list of prescription drugs they will cover.  Any drug not listed on the plan’s formulary will not be eligible for coverage under Part D.  Furthermore, these non-covered prescription drugs are not counted towards overall out of pocket costs for those plans offering a deductible and for the ‘doughnut hole’ coverage gap between $2,250 and $5,100.

The legislation I have introduced would accurately account for a beneficiary’s out of pocket drug expenses during the deductible and the doughnut hole, not just the prescription drugs recognized by the individual insurance plan.  While I did not support the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beneficiaries deserve access to medications as promised by this legislation.  I will work with my colleagues on both sides of the aisle towards providing a meaningful prescription drug benefit that does right by our seniors.  Beneficiaries who are paying tremendous costs for prescription drugs not included in their coverage plan should have those out of pocket expenses be counted during the ‘doughnut hole’ coverage gap that beneficiaries experience when they reach $2,250 in prescription drug expenses.  Affordable access to life saving medications should not be limited, and I will continue to work to ensure that all citizens have fair access to the Medicare Part D prescription drug benefit.