Does anyone Understand the Part D Donut Hole Changes?

[harllee]

DH is on Medicare and has a part D policy. He takes a very expensive drug (Humira) and usually immediately goes into the donut hole. I know there are significant changes o the donut hole this year as part of the ACA. I have been reading about the changes but can't really understand them all. Anyone here understand the changes or can anyone refer me to a good article explaining the changes? Thanks!

[REWahoo]

This is my understanding of the Part D "donut hole" for 2020, compared to 2019:

Quote:

In 2019, Part D beneficiaries paid 37% of the cost of generic drugs while in the donut hole and 25% of the cost for brand name drugs. In 2020, Part D beneficiaries will pay 25% of the cost for both generic drugs and brand name drugs while in the donut hole coverage gap.

Doesn't look like there will be any change to the coverage of non-generics like Humira.

[harllee]

REwahoo, thanks, so the donut hole has not really "closed". DH will still have to pay 25% in the donut hole and then 5% for the rest of the year for Humira?

Humira is a miracle drug for DH but I don't understand why there is no less expensive generic drug or "biosimilar" like there is in Europe available in the U.S. The patent for Humira has expired but still no generics.

[ShokWaveRider]

Quote:

Originally Posted by harllee Humira is a miracle drug for DH but I don't understand why there is no less expensive generic drug or "biosimilar" like there is in Europe available in the U.S. The patent for Humira has expired but still no generics.

Two Words … maybe … "Drug Lobby"

[REWahoo]

Quote:

Originally Posted by harllee REwahoo, thanks, so the donut hole has not really "closed". DH will still have to pay 25% in the donut hole and then 5% for the rest of the year for Humira?

Yes, that's how I understand it.