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A coalition of
drug manufacturers is working on a plan to help millions of
low-income seniors pay for drugs when they hit the so-called
doughnut hole in the new Medicare drug benefit. But the
government warned such a plan to bridge the program's coverage
gap could run afoul of antikickback laws unless properly
structured.
The drug
manufacturers have dubbed their plan Bridge Rx. When
Medicare patients' drug bills reach $2,250 in a year, or amount
to $750 out of their own pockets, they hit this doughnut hole at
which the Medicare plans stop paying the drug costs (or in some
cases pay much less). The plans resume payment after the
patient's drug bills top $5,100, or total $3,600 in
out-of-pocket costs. Under Bridge
Rx, the manufacturers would offer discounts of at least 50%
on their drugs when certain low-income seniors hit the
doughnut hole, according to two people familiar with the
manufacturer's plans. Those in the program would have a
co-pay of at least 15%. The companies hope to announce their
plan in April and launch it in May, these people say.
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Medicare beneficiaries would qualify if they earn between
$14,000 and $18,620. Seniors who make less than $14,000 but have
too many assets to qualify for the Medicare subsidy programs,
would also qualify.
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