A certain percentage of Medicare beneficiaries with chronic conditions are choosing to discontinue their medications once they hit the doughnut hole or gap in their Medicare prescription drug coverage, a report from the Kaiser Family Foundation concluded.
The standard Part D benefit in 2008 has a $275 deductible and 25% coinsurance up to an initial coverage limit of $2,510 in total drug costs, followed by a coverage gapthe so-called doughnut holewhere enrollees pay up to $3,216 in out-of-pocket drug costs, Kaiser explains. Once that amount is spent, insurance kicks in again.
About 3.4 million beneficiaries, or 14% of all Part D enrollees, reached the coverage gap in 2007. Once this took place, Kaiser researchers found evidence of patients changing their use of prescription drugs. Across eight classes of drugs examined (used to treat a variety of common chronic conditions) 15% of Part D enrollees who reached the gap stopped their drug therapy for that condition, the study found. Five percent switched to another medication in the class, and 1% reduced the number of drugs they were taking in the class.
The Medicare drug benefit has produced tangible relief for millions of people, despite the unusual coverage gap that was created to make the benefit fit within budget constraints, Kaiser President and Chief Executive OfficerDrew Altman said in a written statement. But if a new president and Congress consider changes to the drug benefit, it will be important to keep in mind that the coverage gap has consequences for some patients with serious health conditions. -- by Jennifer Lubell