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Medicare Part D 2010 Data Spotlight: Prices for Brand-Name Drugs in the Coverage Gap

This analysis finds prices for some commonly used brand-name drugs rising in 2010 for beneficiaries who reach the coverage gap (or “doughnut hole”), with increases since 2006 far exceeding the growth in inflation.

The Part D benefit’s coverage gap generally requires enrollees to pay the full cost of their drugs after their total drug spending exceeds their initial coverage limit ($2,830 in 2010) until they reach the threshold for receiving catastrophic coverage ($6,440 in 2010). In 2007, an estimated 3.4 million Part D enrollees reached the coverage gap.

Using data posted on the government’s Medicare.gov website, the analysis looks at prices for commonly used brand-name drugs without a generic substitute for enrollees in stand-alone prescription drug plans. The prices reflect the amount that enrollees would pay for a 30-day supply after they reach the coverage gap and before catastrophic coverage begins.

The spotlight is one in a series analyzing key aspects of the Medicare Part D drug plans that will be available to beneficiaries in 2010. These spotlights were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation.

Data Spotlight (.pdf)