By Mike Lillis - 09/29/10 08:31 PM EDT
Millions of seniors enrolled next year in Medicare's prescription drug benefit will have better coverage through the doughnut hole and greater access to brand-name pharmaceuticals than they do now, according to an independent analysis released Wednesday.
Avalere Health, a Washington-based health research group, estimates that one-third of Part D drug plans are offering gap coverage in 2011 — up from 20 percent this year — while the number of plans covering brand-name drugs through the gap will increase three-fold.
Those benefits, the group says, are a consequence of legislative changes in the new health reform law combined with regulatory changes pushed by the Centers for Medicare and Medicaid Services (CMS).
"Increased gap coverage offered by plans will greatly improve beneficiaries’ access to affordable medications in 2011 – and significantly lessen the impact of the donut hole experienced by many seniors, particularly those with multiple chronic illnesses,” Avalere CEO Dan Mendelson said in a statement.
The average Part D beneficiary, Mendelson added, will be able to choose from 11 different plans that offer some coverage through the doughnut hole.
Roughly 17 million seniors participate in Medicare Part, and while polls indicate that beneficiaries are generally happy with the program, the coverage gap can be a painful thorn. That gap, also known as the doughnut hole, forces seniors to pay the full cost for their drugs when annual expenses hit a certain threshold. Only after they've spent thousands of dollars out of pocket does the coverage kick in again.
Under the new reform law, seniors caught in the doughnut hole this year got a check for $250, and next year the cost of brand-name drugs will be slashed by 50 percent.
That provision is largely the reason that more plans will cover branded drugs next year, Avalere notes. Additionally, a new CMS rule limiting the number of similar plans a single Part D sponsor can offer in one region also contributes to the trend, Avalere says.