Doughnut Hole Calculator From AARP Has Limitations

Patients enrolled in Medicare Part D already may be turning up at their physicians' offices asking for a review of their prescriptions -- particularly if those patients have accessed the new AARP Doughnut Hole Calculator.

According to a recent AARP press release, the tool was created to help Medicare Part D beneficiaries avoid the gap in prescription coverage, dubbed the "doughnut hole," that occurs after they've exceeded their basic Medicare Part D coverage but before they reach the catastrophic coverage threshold.

To use the calculator, patients provide information such as their zip code, their Medicare Part D plan and the medications they're currently taking. The online tool calculates beneficiaries' monthly out-of-pocket medication expenses to determine if their prescription costs will push them into the coverage gap.

The tool then searches online drug information databases and peer-reviewed journal articles to develop a list of what AARP calls lower-priced but "therapeutically similar medications" for patients to consider.

Patients then print out personalized letters that include the list of medications to discuss with their physicians.

Although patients may find the doughnut hole calculator a useful money-saving tool, time-strapped physicians should be prepared to spend a few more minutes in the exam room answering prescription-related questions.

The Academy's Practice Support Division reviewed the doughnut hole calculator and cautions that the tool suggests changes to patients' prescriptions for purely economic reasons without any knowledge of the patient's medical history.

"The patient may already have tried less-expensive drug options or may have one or more comorbid conditions that would contraindicate the less expensive recommendations," said Kent Moore, the Academy's manager of health care financing and delivery systems. Some patients may not remember the medications they've tried that didn't work, he added.

The bottom line is that a family physician knows his or her patient's medical history and current situation, said Moore. Those nuggets of information -- along with a patient's financial resources -- play an important role in prescription choices.