Unfortunately for them, it appears that ESRD patients will end up in the Medicare Part D "doughnut hole." A study in the September issue of the Journal of the American Society of Nephrology says that end-stage renal disease patients are likely to fall into the dreaded "doughnut hole" of Medicare's Part D drug benefit, where they exhaust the initial benefit of $2,251 and have to pay almost $3,000 out of pocket until they again qualify for benefits. For more, see this release.