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Closing the doughnut hole.

One of the first provisions of the Patient Protection and Affordable Care Act to take effect is the $250 rebate for Medicare beneficiaries who fall into the Part D doughnut hole.

The first rebate checks were mailed June 10. The rebates are the first step in a multiyear effort to trim drug costs for seniors and other Medicare beneficiaries. Next year, patient cost sharing for brand-name drugs will be cut in half, and the doughnut hole will be closed completely by 2020. Just as checks started hitting seniors' mailboxes, the administration launched a $1 million radio ad campaign designed to help patients protect themselves from fraud, as criminals launch scams targeted at the new benefits.

Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services, answered questions about how the new benefit will be implemented.

CLINICAL PSYCHIATRY NEWS: How many Medicare beneficiaries will fall into the doughnut hole this year? Will they all get checks this summer?

Ms. Tavenner: About 8 million Medicare beneficiaries are expected to reach the prescription drug coverage gap that we call the doughnut hole this year. Of those, 4 million will be eligible to get a tax-free, one-time rebate check. The remaining beneficiaries already receive assistance through Medicare Extra Help. Beneficiaries who hit this coverage gap do not need to fill out any form, or make any phone call, to receive this benefit under the Affordable Care Act. The one-time $250 rebate checks will be mailed automatically to seniors' homes from Medicare when they enter the doughnut hole. The first rebate checks were sent in June, and checks will sent each month throughout this year as more beneficiaries enter the doughnut hole.

CPN: Will the $250 rebate have a significant impact on patients' out-of-pocket drug costs this year?

Ms. Tavenner: The $250 rebate is immediate relief that marks the first step in completely eliminating the doughnur hole. This year's rebate will help put money back in the pockets of seniors who are too often forced to choose between paying for their groceries or for their medications. Next year, seniors who reach the coverage gap will get a 50% discount on brand-name drugs that will help reduce their costs. In addition, under the new law, actual coverage gap will get smaller and smaller every year, until it completely disappears in 2020.

CPN: Physicians in all specialties spend a lot of time helping patients find affordable medications. How will these changes decrease the burden on doctors?

Ms. Tavenner: Physicians are on the front lines in helping seniors obtain medications that are not only successful in treating the patient, but are also affordable. With the coverage gap closed and care more affordable, Medicare beneficiaries will be able to get the care they need and deserve.

And starting next year, patients with Medicare can get free preventive care services like colorectal cancer screening and mammograms. Medicare also will cover an annual physical, where they can work with their physician to develop a personal prevention plan based on current health needs.

CPN: How can physicians help their patients to take advantage of this benefit?

Ms. Tavenner: Doctors can continue to help their patients by educating them about the Affordable Care Act so they can take full advantage of its new benefits. If patients have questions on their rebate checks, they can call 1-800-Medicare or visit And to receive updates on the health reform law as it is implemented, they can visit

One important note: Along with the additional benefits provided by the Affordable Care Act come increased threats of fraud.

That's precisely why we're working with the Department of Justice to crack down on scam artists who are trying to procure personal information from Medicare beneficiaries by promising them rebate checks and other benefits under the law.

Patients should never give their Medicare ID number to anyone promising benefits or discounts under the new law. For fraud-fighting tips, please visit

The Centers for Medicare and Medicaid Services administers the Part D Medicare benefit and will be responsible for implementing many elements of the new health reform law. Ms. Tavenner previously served as secretary of health and human resources for the Commonwealth of Virginia.
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Publication:Clinical Psychiatry News
Article Type:Interview
Date:Aug 1, 2010
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