Medicare Part D – The Donut Hole, Your Doctor, and You

I’m not dead! I swear! I just have been busy with work and not drinking myself into a coma.
The Donut Hole.
Those three magic words that all Medicare Part D patients hope they never hear. The gap in coverage where you must pay out of your own pocket for your medications.
I hold Doctors partially to blame for the shit we have to go through when patients hit their donut hole. Before you give me hate-mail-o-rama, lets elaborate:
You have a patient who is on Medicare Part D. Suddenly, all of these new and spiffy trade-name medications are only $3.10! So what does the doctor do? He starts writing for that ARB when a generic ACE-I is okay. He starts writing for Lipitor when the patient has been on generic Zocor for months. He starts getting blowjobs and lapdances from the drug reps in return for prescribing Levaquin when generic Cipro would be okay. “Hell! Its only $3.10! Why not! The patient only pays $1 for generics, whats another $2.10 for a drug that works ‘better’!!!”.
In reality, the doctor is screwing over the patient, big time. In fact, he’s screwing over the patient more than anyone else could. You see, all of those big expensive trade name medications are going on a tab. A tab that pushes the patient further and further towards the donut hole. So their $2400 allotment of ‘coverage’ is now burnt up in 3 months because Mr “Its only $3.10” Doctor switched them all over to trade name medications. How many doctors realize this? About 10. How many doctors care? Zero.. “Its the pharmacists responsibility to take care of this, even though I’ll deny any generic request he submits!”
So who’s sitting there with their puds in their hands. Isnt the doctor, he gets his kick..er..incentives from the drug companies regardless. Its the patient and the pharmacist. The patient because he now has to pay out of pocket for $2,000 or so dollars until he hits “catastrophic coverage”; and the pharmacist because WE have to explain all of this shit to the patient and hear their whining.
Sure we can switch them all back to generics, but its a catch-22. If you switch them all to generics they’ll be in the donut hole longer (because their total cost of drugs per month decreased due to generic switch). If you keep on the expensive trade name medications, they’ll be out of the donut hole quicker, but will pay more per month. Wonderful isn’t it?
In the defense of doctors, they really have no clue how much stuff costs now days. If you’re a doctor, and reading this, the cost of the drug is directly proportional to how many annoying drug reps come and visit you. Why would a drug that cost pennies be pushed so hard by men in suits and women in short tops? Think about it.

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6 Comments

  1. #1 Dinosaur says:

    Hello: new fan and doctor-who-not-only-knows-but-cares-about-the-costs-of-drugs here.
    Much of the time it’s the patients who pull the “but the insurance covers it” line to get me to give them “real” drugs instead of those “fake” generics.
    That said, you’re right; it fries me when other docs actually believe there’s a meaningful difference between a generic and its branded equivalent.
    On this note, did you see my post about generic albuterol? (TypeKey won’t let me use HTML; here’s the link:)
    http://dinosaurmusings.blogspot.com/2007/02/ozone-is-falling-ozone-is-falling.html
    Keep up the good, angry work.

  2. Nic says:

    If someone has a $3.10 copay then they’re probably a dual or subsidized and don’t have a donut hole. As for everyone else, I think it’s so stupid how people freak when the copay goes up because they hit the donut hole. Anyone remember back before Jan 1, 2006? You didn’t have MedD and you paid for your drugs yourself! I’ve had some patients that no matter how hard I try to convince them that a generic therapeutic equivalent would work just as well, they want what the doc prescribed. I want to tell them, “You bitch about the cost of the brand, but when I suggest something similar that will save you a lot of money, you don’t want it. You can’t bitch if you refuse to switch.”

  3. drcouz says:

    Wrong on many counts.
    1. Family docs are well aware of the costs of the meds. We know which ones are covered by the government for seniors, which ones require a limited use code for coverage and which ones don’t have a generic equivalent. The pharmacists don’t do that for us. If we don’t get it right we get a fax from the pharmacy refusing the script.
    2. Docs get nothing from drug reps for prescribing their products. They’re not allowed to leave anything more than free samples, so no one is getting lap dances out here.
    3. Some newer drugs have evidence behind them (meaning large-scale RCT’s) proving that they work better. And some patients have had side effects or poor response to the older ones. So not every doc prescribing the new med over the old one is doing so with no therapeutic intent.
    Rant away, angry one. But maybe you’ll want to step out behind the counter every now and then and get back in touch with reality.

  4. Healthcare Notes: Rx Costs, House Calls and Match Day

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  5. stl_rxtech says:

    I completely agree on the whole bullshit about medicare part D n the whole “donut hole” shit. at the end of every year i have a ton of customers claiming that their insurance (medicare part d members) don’t have so called coverage gaps and donut holes and YES their insurance covers it! so luckily we all get fuckin yelled at because people are toooo lazy to read about their insurance policies and demand they not be charged that amount. its so sad…

  6. StephRx says:

    Oh, please. RCTs. The ones funded by the drug companies? Please. Private-practice MDs get most of their education from company-sponsored CE (free dinner and free matching duffle bag) unless their medical group sponsors unbiased CE. You are totally right about the donut hole and physician responsibility, and the doctors are right about patients also being responsible for controlling (or not) the cost of their healthcare. Suddenly when they have to pay, you BET they care whether simvastatin works as well as Lipitor. And it does. RCTs prove it.

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