Drug plan deja vu.

Byline: The Register-Guard

Seniors who struggled through the horrendously complex and confusing task of selecting a Medicare prescription drug plan last year have an unpleasant choice awaiting them: Go through the rigmarole of comparison shopping all over again, or risk paying higher premiums by sticking with their current plan.

Wednesday marked the beginning of a new period for Medicare beneficiaries to sign up or change plans. The deadline is Dec. 31, but Medicare officials strongly advise people to act by Dec. 8 to avoid a repeat of the chaos that overwhelmed pharmacies when the Part D plan took effect last January.

It won't be easy to motivate seniors to re-enter the Byzantine world of Medicare prescription drug plans. Surveys suggest that three out of four participants are satisfied with their current plan, and few people would willingly return to the mind-numbing chore of comparing 50 different plans with 50 different lists of covered drugs.

But the industry-friendly legislation that created the prescription drug benefit allows insurance companies to change their plans every year. Some of the most popular plans will charge much higher premiums in 2007.

An analysis by the health care consumer advocacy organization Families USA found that 77 percent of Medicare Part D beneficiaries are enrolled in plans that will raise premium charges in 2007, and more than one-fourth are in plans that will hike rates by at least 25 percent.

Many plans also are revising co-pays for covered drugs, typically lowering charges for generic drugs and raising them for brand-name drugs. The problem is that a number of brand-name drugs commonly used by seniors don't have generic alternatives.

The price disparity between generic and brand-name drugs becomes crucial for Part D participants who fall into the dreaded "doughnut hole" - a $2,850 gap in drug coverage built into the plan to lower its astronomical costs. The doughnut hole opens after a person has used $2,250 in coverage, not counting co-pays and deductibles. Medicare beneficiaries in the doughnut hole must continue to pay their monthly premiums as well as the full cost of their prescription drugs until their expenses total $5,100, after which coverage under Part D resumes.

It gets worse. The doughnut hole isn't fixed; it expands as drug prices increase, which they have a documented tendency to do. In 2007, the doughnut hole will grow to $3,051.

Naturally, the insurance industry has responded to a need created by its effective lobbyists. Policies are available in 46 states to bridge the coverage gap. But next year such policies will be offered in just 37 states, increasing the number of seniors without coverage from 375,000 to 6.3 million. Even where it's available, doughnut hole coverage will increase in price by an average of 87 percent, according to Families USA.

Most doughnut hole policies will cover only generic drugs, but just seven of the 25 medicines most commonly prescribed for seniors are available as generics. Policies for brand-name drug coverage, if available, would be much more expensive than the generic alternatives.

The Republican-crafted prescription drug plan is a monument to the pitfalls of allowing industry lobbyists to write their own legislation. Fixing it may be impossible, but at least the Democrats have pledged to give it a go when they are in the majority come January. Removing the industry-designed prohibition against allowing Medicare to negotiate directly with drug companies for discounts is an important, if humble, first step.