Furfaro who previously had a heart-transplant, discovered he’d hit the doughnut hole (coverage gap)last month after getting refills for immunosuppressants. medications. The pharmacist charged him $661 and $329 for the prescriptions, instead of his co-pays.
Furfaro wasn’t told about the doughnut hole when his coverage changed in January.
“I threw a fit. What am I supposed to do? I don’t have $661 in my pocket. I thought, `That’s it. It’s over.’ The three years I put into the transplant, the waiting and everything. It was a waste of time because I can’t get my medicine.”
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His father purchased the cheaper drug of the two. However, Furfaro has gone more than three weeks without a prescription to prevent severe organ rejection and has been receiving Social Seurity Disabiity. Despite that, he recently took a position as a security guard to pay for his prescritptions
Furfaro is having health problems.
“I lay around a lot. I don’t have a lot of energy. I’m short of breath. I don’t feel well at all.”
If his health contnues to deteriorate, he’ll be admitted to the hospital to receive his medicine. Medicare will pay all bills for a hospitalization.
Robert Hayes of the Medicare Rights Center:
“Millions of people and millions more family members are going to be experiencing this shocking and crushing problem. That’s what happens when people can’t get the basic care they need. And medicine is basic care.”
Hayes also added that he expects that scenario to occur repeatedly across the country.
If Congress had premitted Medicare to negotiate for the best price of prescriptions, the savings would allow for prescription coverage with no interruptions. Another problem is the insistence on the donut hole in the Part D legislation.
Juliette Cubanski, of the Kaiser Family Foundation,
“[The donut hole] is not something we’ve ever seen in any other insurance product that I’m aware of.”