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.

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.

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.

We offer some guidelines to finding legitimate online pharmacies in our Guide to Saving Money on Medicine. Anyone who would like a copy, please send $2 in check or money order with a long (No. 10), stamped (59 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. CA-99, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our Web site: peoplespharmacy.com.

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: 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 thought this disease could only be caught through a sexual encounter. What are 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: 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.

We are sending you our Guide to Cholesterol and Heart Health with more information about these medications so you can discuss them with your doctor. Anyone who would like a copy, please send $2 in check or money order with a long (No. 10), stamped (59 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. C-8, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our Web site: www.peoplespharmacy.com.

"The People's Pharmacy with Joe and Terry Graedon" airs Saturday at 7 a.m. on WVTF (89.1) and at 4 p.m. Saturdays and Sundays on RADIO IQ (89.7).