Diabetes and Medicare: One Patient's Story

If you have diabetes and are on Medicare, you may encounter a "doughnut hole" that has nothing to do with sugary goodness.

Although 2003 legislation created Medicare Part D to pay for prescription drugs, there is a gap in coverage known as the doughnut hole that occurs when the federal government stops paying for drug purchases as an annual limit is reached. Once a patient hits that limit, the government picks up the tab again only after the patient has spent thousands of dollars.

Dick Robbins, 72, who lives in Hot Springs Village, Ark., discovered this after he reached his reimbursement limit in 2007.

"It's a financial burden—part D Medicare doesn't cover a heck of a lot of the stuff I use, they only cover part of it," said Robbins while he was in the doughnut hole. "Now I pay full price for everything I take." Robbins is taking metformin and two types of insulin, Novolog and Lantus. The medication and syringes are costing him up to $300 a month with Medicare's help and up to $800 a month when he has to pay it all himself.

My feeling is, one of the villages in America is missing its idiot, and he's working for this health-care company.

—Dick Robbins, Type 2 Diabetes Patient

His part D health-care provider only allows him to fill one-month supplies of medication, and he once got dangerously close to running out of insulin. His doctor had verbally upped his prescription without increasing the dosage at the pharmacy. Following his doctor's new instructions, Robbins ran out of medication a day early and had to convince his provider to authorize his prescription for the next month in advance.

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"Last month I was down to one shot left and I called my part D provider and said, 'Look it's going to cost more to take care of me if I don't have the insulin than it does to pay for the insulin.' So they authorized the insulin," he says.

"My feeling is, one of the villages in America is missing its idiot, and he's working for this health-care company."

Resources to manage costs

If you are on Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. For more information, go to the "Getting the Help You Need" section of the online publication Medicare & You 2008.

If you don't have prescription drug coverage, you may qualify for free or low-cost prescriptions. The Partnership for Prescription Assistance, a pharmaceutical industry-sponsored initiative, can tell you more.

The American Diabetes Association has more about coverage of diabetes costs by Medicare, Medicaid, and private health insurers.