KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Does Medicare ‘Doughnut Hole’ Spur Increase In Foreign Drug Imports?

Medill Reports: "Unless federal legislation closes the Medicare coverage gap colloquially known as the 'doughnut hole,' seniors may opt for online drug imports to alleviate steep prescription costs. ... 'As seniors start falling into the doughnut hole, they are going online to find deals on prescription drugs, whether they're based in the U.S. or in other countries,' said Gabriel Levitt, vice president of LLC, a leader in the evaluation of online and mail-order pharmacies in both the U.S. and abroad. 'And they should be wary of doing so because there are many rogue pharmacies out there.'"

Medill notes that "nearly all prescription drugs imported into the U.S. for personal use-which lack approval by the U.S. Food and Drug Administration-are illegal" (Mead, 3/10).

Meanwhile, The Associated Press reports that "[f]ederal regulators have banned an insurer from selling Medicare prescription drug coverage and accused it of improperly delaying and denying coverage of HIV, cancer and seizure medications. The Centers for Medicare and Medicaid Services said Fox Insurance Co. 'jeopardized the health and safety' of its enrollees. The privately held New York insurer provided Medicare prescription drug, or Part D coverage, to more than 123,000 Medicare beneficiaries in 21 states." According to CMS, "customers will be transferred to a prescription drug plan run by Humana Inc., and they should not see delays in drug access" (Murphy, 3/10).

McKnight's Long Term Care News: "A review earlier this month found that Fox had enacted policies that limited access to high-cost drugs. The company also made obtaining other drugs more difficult. In some instances, Fox required beneficiaries to undergo unnecessary invasive procedures before allowing access to prescription drugs, according to CMS" (3/11). 

The Tucson Citizen: the Fox case "is an example of how Medicare is clamping down on insurance companies and responding to complaints about problems" (3/10).

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