This ‘doughnut’ isn’t sweet

            DURHAM, NC - Medicare recipients with end-stage renal disease (ESRD) are a high-risk group for higher medication costs related to a gap in coverage - the so-called "doughnut hole," $2,251 to $5,100 in medication expenses - in the Medicare Part D prescription drug plan, suggests a study in the Journal of the American Society of Nephrology. People with ESRD have permanent loss of kidney function requiring dialysis or kidney transplantation. "The majority of ESRD beneficiaries will have medication costs that land them in the 'doughnut hole’," said Dr. Uptal D. Patel, of Duke University , lead author. "However, nearly half will not receive catastrophic coverage for relief from high drug costs." Studies found ESRD patients take an average 8-13 drugs, far more than most other Medicare beneficiaries. To estimate Part D's impact on adults with ESRD, scientists analyzed survey data on prescription drug use and costs for nearly 42,000 Medicare beneficiaries. Estimated 2006 costs for those with ESRD were about $6,500, more than twice $2,700 for those without ESRD. Overall, Part D cut out-of-pocket costs for beneficiaries with and without ESRD. A sharp drop in costs was expected for beneficiaries who had no prescription coverage previously. Those who had employer-sponsored drug coverage were likely to have a substantial hike. However, because of their higher overall costs, patients with ESRD were more likely to reach the Part D coverage gap: 70% of ESRD beneficiaries were estimated to fall into the "doughnut hole" versus 43% of non-ESRD patients. Patients with ESRD were three times more likely to reach the "catastrophic" threshold: 39% versus 14%.