Healthcare costs continue to be a concern, despite efforts underway to reduce them through healthcare reform initiatives.  One area, in particular, is worrying patients and physicians alike: specialty drugs or biologics. An article in Workforce Management reports that specialty drugs “make up about 17% of employers’ total drug costs, even though just 1% of the workforce takes them.”  Reuters reports that “approximately 57 million Americans rely on specialty drugs,” with the average prescription costing $1,766.00 in 2011.

“Specialty drugs are high-cost drugs used to treat complex or rare conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C and hemophilia. The drugs are often self-injected or administered in a physician’s office or through home health services,” according to Wellmark. Specialty pharmacies specialize in the delivery and clinical management of specialty drugs.  It is reported that the average cost per specialty medication is $2,000.00 per month,

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The passing of the Affordable Care Act has implemented a number of changes to American healthcare. Many of these changes directly affect families, the elderly, and people with pre-existing conditions, leaving many of 20-somethings wondering “What does this mean for me?” One major impact of the new law is that young adults can stay on their parents’ healthcare plan until age 26. Before the passing of the Affordable Care Act children could only stay on their parents’ insurance up to age 19, with exceptions for full-time students. Since the law has been enacted, over 3 million young adults have gained insurance.

As a recent college graduate, I took full advantage of the new law and remained on my parents’ insurance until 26. After that I had options – lots of options – most of which I knew very little about (sound familiar?). I did know that as a Massachusetts resident I had to be insured, or I would face an increase on my taxes.

The first option was to wait for an open enrollment period and get back on my parents’

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Today, we are hoping to provide answers to some of your questions about the Donut Hole! Tell us about your experiences. We would love to hear from you.

 1.    What is the donut hole? To answer that question, we first need to understand Medicare and Part D.

According to Jonathan Blum, Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services, Medicare is the federal health insurance program for people 65 or older, people under 65 with certain disabilities, and people with End-Stage Renal Disease (permanent kidney failure).  People with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D.

Basic Medicare Part D coverage works like this:

  • You pay out-of-pocket for monthly Part D premiums all year.
  • You pay 100% of your drug costs until you reach the $310.00 deductible amount.
  • After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2970.00.
  • Once you reach this limit, you have hit the coverage gap referred to as the “donut hole,” and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit of $4,550.
  • After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs.

2.    What is the structure, e.g., cut-offs, coverage amounts and patient payment percentages?

The “donut hole” refers to a gap in prescription drug coverage under Medicare Part D. In, 2013, once you reach $2,970 in prescription drug costs (which include both your share of covered drugs and the amount paid by your insurance), you will be in the

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You take your sick child to the doctor. An exam is done, a diagnosis made, a prescription written, and instructions given to the parent. The next step: a trip to the pharmacy to have the prescription filled so the child can start the medicine as soon as possible. Right? Why, then, did a recent study reveal that up to 25% of children’s prescriptions remain unfilled?

Investigators are currently examining whether electronic prescriptions are filled more often (because the patient does not have the opportunity to lose or misplace it), or if, in fact a written prescription serves as a tangible reminder to go to the pharmacy to get the prescription filled.

Other researchers are looking at the rate of prescriptions being filled as a result of a well-child visit versus that of a sick-child visit. Some early findings are showing that prescriptions given at sick-child visits are filled more often than those given at well-child visits.

For the uninsured and underinsured, the costs of prescription medications can be daunting. Even for those who have health insurance, co-pays and deductibles mean that many still struggle to afford the costs of

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The development of vaccines to protect against potentially killer diseases likes polio, measles and pertussis (whooping cough) has been widely hailed as one of the crowning achievements of medicine in the 20th century.  As the table below shows, the incidence of these, and other diseases, decreased by between 95-100% once vaccines were given. Many of us can likely remember hearing stories of family members who died from these diseases, or who were otherwise seriously and permanently affected from having suffered from these diseases. But are we taking this standard of care for granted?

According to a recent study reported by Reuters, “Nearly half of babies and toddlers in the United States aren’t getting recommended vaccines on time – and if enough skip vaccines, whole schools or communities could be vulnerable to diseases such as whooping cough and measles.”

We are seeing the effects of “under-vaccination” already as outbreaks of pertussis (whooping cough) are becoming increasingly

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