Donut Hole is Good for Business – Bad for Care

January and February are good for business at my family practice.  One might think I am speaking of influenza outbreaks and increased patient visits for colds and sinus infections.  But in my office, the first months of the year are filled with visits to help my patients dig out of the donut hole – Medicare part D’s ill conceived drug benefit coverage gap.
Many of my adult patients, especially those on respiratory medicines, fall into the donut hole late in the year.  They often go off their medicines for a few months or they visit me in November to see if there might be a less expensive alternative for them to get by until January 1st.  The U.S. Department of Health and Human Services estimates that more than a quarter of Part D participants stop following their prescribed regimen of drugs when they enter the donut hole.  During their time in the donut hole they face increased blood pressures, shortness of breath and other exacerbations of their chronic conditions.
When January comes, they come flocking back to my office to get back on the medicines they were and will again be stable on until late in the year when the cycle repeats.
Thankfully, my patients can look forward to a more complete pastry in the years ahead.  Under the Affordable Care Act the donut hole shrinks each year until it completely closes in 2020.  Until then I will make room in my January and February schedule for this type of visit.