Patients, even those who benefit from Part D prescription drug coverage, encounter many of the same frustrations that face their rheumatologists. Phyllis, a retired New York teacher with RA now living in California, has worked out a plan that combines Part D coverage with her New York retirement coverage to handle the financial costs, but she is frustrated with Part D’s restrictions on self-injections and infusions and the prior authorization required for oral medications. She considers herself fortunate to be in good health except for RA, but she thinks the administration of Part D is unnecessarily complicated.
Explore this issueJanuary 2007
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Another patient, Chuck, turned to his state—Illinois—seeking prescription drug coverage and discovered that once he proved he qualified, state coverage was more comprehensive and less confusing than signing up for Part D,so he chose not to enroll. However, Chuck manages a support group for arthritis patients and tries to help his members navigate through Part D enrollment.
He reports that his members find Part D extremely confusing. Many, for example, do not understand that Part D is renewed each year and that, therefore, the doughnut hole (the gap in coverage during which all of the expensive rheumatic medications are paid for out-of-pocket) reappears annually—knowledge gaps are as widespread as doughnut hole gaps, he notes.