The Part D of Medicare has a huge coverage gap which gets this cute little nickname of "donut-hole" which maligns the goodness of donuts and implies the gap isn't that bad. It is bad for the elderly and the sickest and the poorest.
The problematic legislation, which Congress created with much help from pharmaceutical companies, prevents the government from negotiating for lower prices and requires that premiums be paid for coverage even while the individual has no coverage.
Congress needs to review this, but they won't. Elderly, disable, sick or dying Americans seldom get the chance to take a congressman or senator to dinner.
Good coverage on this problem is here, and here is an excerpt:
"This colossal gap in coverage (which, you may notice, is larger than the initial coverage itself) is popularly known as “the doughnut hole.” Even worse, those who have fallen into the doughnut hole must still pay their monthly premiums, even though they are paying every last cent of their drug costs during this period out of their own pockets. Talk about adding insult to injury.
It’s hard to say for sure how many people will fall out into the doughnut hole. The best guess available comes from the Kaiser Family Foundation, whose conservative estimate is that almost 7 million people will reach the gap in 2006. Out of these, many will never be able to spend the $2,850 required to get out of it. And the doughnut hole is getting bigger every year: The law is written in such a way that the actual amount of money that people will have to spend to get out of the hole is going to increase annually."
And even after Part D was crafted, big pharma still increased their prices to make sure you hit that hole quicker.