Senior citizens are getting slammed. Just when their retirement savings are being affected by the Wall Street boondoggle, they will have to pay more for Medicare drug coverage in 2009.

October 7, 2008

Here's a quick refresher on the Part D Medicare prescription-drug plan. In 2005, politicians reacted to growing outrage from older citizens. These voters were fed up with skyrocketing medication prices and demanded relief. The response was Part D of Medicare, which launched in January of 2006. There were penalties for older people who failed to select a plan from one of the competing insurers, so most signed up.

In the beginning, people were pleased. After the initial $250 deductible was paid, the government picked up 75 percent of prescription drug costs up to $2,250. For people with modest medication needs, this was a real blessing.

But those who needed more medicine fell into the dreaded doughnut hole. This often happened around August or September. A bottle of pills that cost $30 in March might cost $120 or more by October.

In addition to their monthly insurance premiums, seniors in the hole had to pay 100 percent of their prescription-drug costs until the total outlay for the year reached $5,100. If their bills exceeded that amount, they emerged from the doughnut hole and 95 percent of their drug costs were paid by the government until the whole process started again in January of the next year.

If that sounds complicated, it is. Pharmaceutical manufacturers love Medicare Part D because it has boosted revenues. The government caved in to drug companies' demands not to negotiate prices, so patients and taxpayers pay full price.

Now, premium prices are rising again. According to government analysts, the average insurance premium for Part D will go up about 24 percent, from roughly $30 a month to $37. On top of rising prescription prices, this will take a bite out of a fixed income.

One reader asked for help: "My husband reached the doughnut hole by June taking both Elmiron and Flomax for interstitial cystitis. Elmiron costs $960 for a three-month supply. It is the only specific drug for this condition. Is there a legitimate pharmacy outside this country where I can purchase these medications more affordably?"

Not surprisingly, many seniors look for more affordable ways to buy their prescription medicines once they hit the doughnut hole. Buying Elmiron from a legitimate online Canadian drugstore could cost around $500 for a three-month supply. That's a significant savings.

The only trouble with this approach is that any medicines purchased outside the country do not count toward getting out of the doughnut hole. If total drug costs will exceed $5,726.25 in 2008, it might make more sense to bite the bullet and get the benefit of a 95 percent subsidy on the other side of the doughnut hole.



Q. I am seeing a new guy, and the stubble on his face has left a large chapped area on my face that almost feels burned. It's an unpleasant aftermath of an enjoyable kissing session. I'm putting Vaseline on it. Is there anything else that might help more?

A. We checked with cosmetics expert Stanley B. Levy, M.D., of Chapel Hill Dermatology in North Carolina. He said you can use 1 percent hydrocortisone cream for a few days. It is available over the counter.

To prevent or soothe irritation, Aquaphor (made by Beiersdorf) would feel and work better than Vaseline. It, too, is OTC.

Dr. Levy continued: "Make sure you are not sensitive to his aftershave, moisturizer or lip balm. Although the grizzly look is in, you also could ask him to shave more frequently."



Q. I believe my friend was sleep-driving when he was killed in a car accident. A dump truck slammed into his car at an intersection he'd known all his life. It was only two blocks from his house.

I called his wife to get the story, and she said he reportedly ran a blatant red light on his way to work. That is certainly not like him, especially because he was applying for a police job. If you're doing that, you don't go through red lights, for sure.

When I'd talked with him not five days earlier, he had told me he was on Ambien. He said if he didn't get enough sleep he would do strange things. I feel the Ambien caused him, a husband and father of two, to be killed needlessly because he was probably sleep-driving under its influence.

A. Ambien has been linked to "sleep-driving." Whether this sleeping pill was responsible for your friend's accident is impossible to tell. Others have shared stories of bizarre behavior (including sleep-driving) under the influence of Ambien (zolpidem).

Many people are able to take Ambien safely, but others need a different approach for dealing with insomnia. Some people wake early in the morning and cannot get back to sleep. For them, a shorter-acting drug like Sonata may be preferable.



Q. A friend of mine just announced that she has genital herpes. She has had it for quite a few years and has never told her husband.

She claims she contracted herpes from a low immune system due to chronic arthritis. I always thought this disease could only be caught through a sexual encounter. Can you bring me up to snuff on the causes of "genital herpes" ?

A. You are correct that genital herpes is a sexually transmitted disease. Your friend is mistaken either about her diagnosis or about the way she acquired it. We are surprised that she has not informed her husband, since he is at risk for catching the disease whenever they make love.



Q. I read your coconut macaroon article and asked my doctor about using coconut instead of my Crohn's medicine. He said that he has seen it work for others and to give it a try. He said to add pineapple for anti-inflammatory properties.

I have been eating a large pinch of coconut morning and evening for five months and have no Crohn's symptoms. I add the pineapple a couple of times a week.

A. We are pleased coconut has helped. Not everyone will benefit, however, and a physician should be involved in such decisions.

Donald Agar in Pittsfield, Mass., first discovered that Archway Coconut Macaroon cookies stopped the chronic diarrhea associated with Crohn's (inflammatory bowel disease). He shared his success with us 10 years ago in this column.

Pineapple contains bromelain, an enzyme with anti-inflammatory activity. Yours is the first report that pineapple also might be beneficial for Crohn's.



Q. My cholesterol is high, but I cannot tolerate statin-type drugs. My doctor has prescribed Lipitor, Zocor and Crestor. They all make my muscles and joints hurt. Now he wants to prescribe Vytorin.

I am reluctant to try yet another cholesterol-lowering drug, especially since I have heard bad things about this medicine. What else can I take to get my cholesterol under control?

A. Since you have already reacted badly to Zocor (simvastatin), it is unlikely that Vytorin will solve the problem. It contains both simvastatin and ezetimibe (Zetia). There is a controversy about whether Vytorin is associated with an increased risk of cancer (New England Journal of Medicine, Sept. 25, 2008). An editorial in this journal concluded: "Physicians and patients are unfortunately left for now with uncertainty about the efficacy and safety of the drug."

There are several other ways to lower cholesterol. Psyllium fiber has a modest lipid-lowering effect. Niacin also may be beneficial when taken under medical supervision. Other nonstatin drugs include Colestid, Tricor and WelChol. Fish oil can reduce both LDL cholesterol and triglycerides.



Q. Once my wife and I had children, I began to get several colds every winter. Of course, the kids would recover in a couple of days, but my own congestion would last a couple of weeks.

Eventually, I would get a sinus infection and have to get a prescription for antibiotics. This pattern continued for five years without fail.

Then I began a low-carb diet to lose weight. As a side effect, I noticed that my nasal congestion was reduced almost immediately. No longer did I spend five minutes every morning clearing my throat and blowing my nose. In the four years since I cut my sugar intake as part of the diet, I have had one cold (which lasted less than a week) and no sinus infections. Others may also benefit.

A. Thanks for sharing your experience. We haven't seen this benefit mentioned in studies comparing low-carb to low-fat diets.