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Seniors in ‘Gap’ cut back Medicines

Pharmacists are always telling me that patients don’t fill prescriptions when they hit the doughnut hole in Medicare Part D coverage. This week Yuting Zhang, Assistant Professor Of Health Economics at Pitt’s Graduate School of Public Health, and her co-authors, released a report that shows seniors cut back on their medications by 14 percent. Interestingly when they looked at patients who had zero copay coverage on generics from an HMO, there was no cutback in prescriptions. We should make sure all of our patients can afford the medications we write for them.

Seniors in ‘Gap’ cut back Medicines
Yuting Zhang, Assistant Professor Of Health Economics
 Pitt Graduate School Of Public Health

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. To offset the added expense for the program, a beneficiary’s contribution in the first phase could be slightly increased.
The Pitt study is published in today’s (date?) online issue of Health Affairs magazine.

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, their medication use went down 14 percent, dropping on average one of the five prescriptions.

Because those with HMO type generic drug coverage with no limit 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.”