As the push to overhaul the

 nation’s health care system moves to the U.S. Senate, strengthening the Medicare prescription drug benefit — Medicare Part D — is emerging as one of the highest priorities for older Montanans. Probably no aspect of the Medicare Part D program has caused more confusion and irritation than the notorious “doughnut hole,” where prescription drug coverage stops but monthly premiums do not.

Your Medicare Part D prescription drug coverage has a phase when you are responsible for all of your prescription drug costs. This interval is called the “coverage gap” or “doughnut hole.”

In the odd structure of Medicare Part D, there is an initial $295 deductible, which means you are responsible for all of your prescription drug costs until they exceed $295. After you have spent $295, you pay 25 percent of your prescription drug costs until your total spending reaches $2,700.

When your drug costs total $2,700 you reach the infamous doughnut hole and, even though you are still required to pay your Medicare Part D premiums, you generally are responsible for all of your prescription drug costs until your total drug spending reaches $6,154. At that point you enter catastrophic coverage and begin getting help with your prescription drug costs again. You are responsible for 5 percent of your prescription drug costs after you reach catastrophic coverage.

Drug prices rise

Prescription drugs play a vital role in managing or curing diseases and improving the quality of life for Americans of all ages. Unfortunately the doughnut hole results in prescription drug costs that many of our seniors cannot afford. Last year, 33 percent of Montanans on Medicare Part D fell into the dreaded doughnut hole — that’s nearly 22,000 Montanans who had to pay 100 percent of their prescription drug costs for at least part of the year, and this number is increasing each year.

The doughnut hole is getting worse each year because the gap in coverage is tied to Medicare Part D beneficiaries’ prescription drug spending. Drug prices continue to climb despite lack of growth in the general inflation rate. In fact, according to a recent study by the AARP Public Policy Institute, the price of brand-name prescriptions most widely used by Medicare beneficiaries increased by 9.3 percent in the past year and was much higher than the rate of increase during any of the prior seven years. As a result, the doughnut hole is expected to almost double in size by 2016.

AARP applauds Sen. Max Baucus for his leadership on a provision that would substantially fill in the doughnut hole. Under the Baucus plan, drug makers have committed to $80 billion in savings — including providing a 50 percent discount on brand name drugs for people caught in the doughnut hole.

Fight continues

Unfortunately, many Montanans who fall into the coverage gap stop taking their medications because they simply cannot afford them. For those who do not have a choice to switch to generic pharmaceuticals, however, this provision is a major win that will help ensure that they can afford the prescription drugs they need.

AARP endorsed the House plan in part because it closes the dreaded Part D doughnut hole and allows Medicare to negotiate lower drug prices for Part D beneficiaries.

While AARP is pleased to see these important steps forward, we know the fight is not over. We will continue to work with Baucus to ensure any final health care reform bill meets the needs of older Americans. AARP will continue to advocate for lower prescription drug prices and the complete closure of the Medicare Part D doughnut hole so that every American can afford the prescription drugs they need to stay healthy.

Bob Bartholomew of Helena is AARP Montana state director.