Like many senior citizens, John North, (not his real name), 62, a resident of Hillcrest, finds Medicare Part D frustrating.

“I have found Part D to just be a nightmare of a maze of confusing choices and loopholes, and I had the worst time trying to figure it out on my own,” North said.

Medicare Part D is a federal program to subsidize the cost of prescription drugs for Medicare beneficiaries. It was enacted as part of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) and went into effect on Jan. 1, 2006.

North is HIV positive.

“I have a basic cocktail of HIV meds and one additional medication, which is a type of psychotropic medication,” he said.

“The costs of these medications is outrageous,” said North, whose main concern is getting all of his medications paid for.

Compared to the typical senior citizen, those living with HIV on Part D have it far worse, said Robin Williamson, vice president of the gay-owned Community Prescription Center in Hillcrest.

“Medicare Part D has a much greater consequence for HIV-positive people than senior citizens just because of the drastic cost of medication and the difficulty of getting certain very expensive drugs covered under certain plans,” said Williamson.

The root of the problem is the “donut hole.”

The “donut hole” is a funding gap in Medicare Part D prescription coverage that requires beneficiaries who surpass $2,250 in drug costs to pay $3,600 out-of-pocket before the government will again resume subsidizing their prescriptions, as stated in a June 2006 AARP Bulletin report.

Before falling into the “donut hole,” beneficiaries have to pay 25 percent of their drug costs and a monthly deductible. Once Medicare members surpass the “hole,” the government then pays 95 percent of prescription costs, again reported in the AARP report.

“For most people, if you are faced individually with paying $3,600 cash out of pocket before the government will pick up again, it’s really daunting,” said Williamson. “If you’re an HIV patient, you’re probably going to use up your initial $2,250 allotment from the government in probably 30 or 60 days taking HIV medications.

“For example, my father who takes a high cholesterol and hyper-tension medication, for him, with all the careful planning and the fact that he can get generic drugs, he can go the entire year without falling into the donut hole. So for his entire year, he pays his entire year around 20 and 30 dollars a month and has his medications taken care of,” Williamson said.

“But if you’re trying to get a very expensive HIV medication that might cost $1,000, which is not uncommon, many people experience difficulties with getting it covered. Some plans under Plan D will cover it, but a number of other plans won’t,” Williamson said.

“The bottom line is that the dollar amount for my meds comes to more than $2,000 a month. There’s no way on my income I would be able to handle that without some sort of health care type plan to help pay for that stuff,” North said.

North is lucky. His last pharmacist referred him to Community Prescription Center in Hillcrest, which provides free advising on Medicare Part D.

“I contacted Community Prescription Center, and they sat down with me personally in a confidential setting and went over things and explained choices to me and saved me a lot of aggravation and grief and time,” North said.

“If I wouldn’t have gotten someone who knew how to implement this thing, I would have been lost with it. I probably would have ended up with some company that I would have pulled off the government list of available pharmacies to use and would have cost me a great deal of more money,” North said.

“For most of our patients, they will have to live with their choice that they make for the next 12 months…. That’s going to impact who covers their prescriptions and how much they pay for the entire year,” Williamson said.

“And it’s not usually just a five-minute question with that; that’s why we specifically set up appointments for our patients to come in, because its usually a half an hour – you know, a typical Medicare Part D patient for us right now,” Williamson said.

“We typically see people that have more unique needs. We see a lot of HIV patients; we see a lot of hepatitis patients. We see a lot of patients who are diabetic, things that are something other than your typical high blood pressure patient. We have plenty of those as well. But because so many of our patients have a larger number of prescriptions, we just feel that it’s necessary to not do that,” Williamson said.

Community Prescription Center will be providing free confidential counseling to Medicare Part D beneficiaries until the end of this month. To schedule an appointment call Frank Sabatini Jr. at 619-925-3794.