Seniors with Part D coverage cut back on medication once they hit the "doughnut hole" coverage gap
03 02 09 - 12:09
Study: Seniors in 'gap' cut back medicines
By Steve Twedt, Pittsburgh Post-Gazette
Seniors participating in the Part D Medicare Advantage prescription program cut back on their medications by 14 percent once they hit the "doughnut hole" coverage gap, raising questions about possible risks to their health.
A new study from the University of Pittsburgh Graduate School of Public Health suggests that a better approach might be adding coverage for generic medication -- for about one-fourth the cost of a brand name drug -- during the coverage gap. Then, to offset the added expense for the program, a beneficiary's contribution in the first phase would be slightly increased.
The Pitt study is published in today's online issue of Health Affairs magazine.
The lead author is Yuting Zhang, assistant professor of health economics at Pitt's Graduate School of Public Health, and her co-authors are Pitt colleagues Judith Lave and Julie Donohue, and Joseph Newhouse of Harvard University.
Medicare Part D, enacted three years ago, is meant to help seniors who face huge medication bills. Under the plan, beneficiaries have an initial $250 deductible for prescriptions, then a 25 percent co-payment until they reach $2,250 in payments.
After that the coverage gap, or doughnut hole, goes into effect and seniors pay 100 percent of their drug costs until costs reached $5,100, after which about 95 percent of the costs are covered.
The study looked at medication purchase practices of more than 11,000 Part D members and found that about 25 percent of Part D participants hit the doughnut hole coverage gap. About 4 percent progressed to become eligible for the catastrophic coverage.
Typically, those reaching the doughnut hole coverage gap were seniors with chronic conditions such as diabetes or hypertension who filled an average of five prescriptions per month.
Once they hit the doughnut hole, though, their medication use dropped 14 percent, dropping on average nearly one of the five prescriptions.
Because those with generic drug coverage did not see such a drop, "one can assume not only that the lack of coverage in the doughnut hole had adverse health consequences but also that it could have increased costs for hospital and physician services," the authors concluded.