Seniors in Medicare's doughnut hole decrease use of meds

Feb 03, 2009

Beneficiaries enrolled in Medicare Part D who reached a gap in health care coverage known as the "doughnut hole" were much less likely to use prescription drugs than those with an employer-based plan, according to a University of Pittsburgh Graduate School of Public Health study.

The findings, published in the Feb. 3 online issue of Health Affairs, raise concerns about health consequences and increased costs from hospitalizations and physician visits that may arise from lack of coverage. To protect seniors, the authors suggest a change in policy that would mandate the coverage of generic drugs in the doughnut hole through a modest increase in initial prescription co-pays.

Medicare Part D, which offers prescription drug coverage for Medicare beneficiaries, took effect in January 2006. A controversial aspect of its design is the doughnut hole, a gap in coverage of prescription drugs that in 2006 occurred when annual individual drug expenditures reached $2,250. The purpose of the annual spending cap is to keep the cost of the program within federally approved limits. Since its inception, "there have been few studies to tell us what happens to beneficiaries once they enter the doughnut hole," said the study's lead author, Yuting Zhang, Ph.D., assistant professor of health economics at the University of Pittsburgh Graduate School of Public Health.

Dr. Zhang and colleagues compared two groups of senior citizens with Medicare drug coverage provided by a large Pennsylvania insurer in 2006. One group was covered through more generous employer-sponsored plans with full coverage in the doughnut hole and the other was covered through Medicare Advantage prescription drug plans (MA-PD) with either no doughnut hole drug coverage or generic coverage only.

They found that one in four (25 percent) of Pennsylvanians enrolled in an MA-PD reached the doughnut hole, but only one in 20 (5 percent) of that subset of individuals went on to reach the catastrophic phase of coverage - when annual drug spending reached $5,100 and Part D coverage of drugs resumed.

In addition, Medicare beneficiaries who lacked coverage in the doughnut hole reduced their monthly prescriptions by 14 percent per month once they entered the doughnut hole. Those with generic coverage in the doughnut hole decreased their monthly prescriptions by only 3 percent, and those who were enrolled in employer-based plans had no changes in monthly prescriptions when they reached the doughnut hole spending level.

The study also found that Medicare beneficiaries with diabetes were more likely to reach the doughnut hole than those with hypertension, and they reached it sooner. Those with more than one chronic illness also were much more likely to reach the doughnut hole - 34 percent with both hypertension and diabetes reached it, and 61 percent of those with hypertension, hyperlipidemia, congestive heart failure and diabetes did so.

"Our findings raise concerns about whether people with chronic illnesses who lack doughnut hole coverage are able to effectively manage their conditions," said Dr. Zhang. "Without needed prescriptions, we could potentially see an increase in hospital and physician costs."

To fill the gap, Dr. Zhang and colleagues suggest mandating the coverage of generic drugs in the doughnut hole and off-setting government costs by allowing plans to assess larger co-pays on prescription drugs prior to entering the doughnut hole. Increasing the current initial 25 percent co-pay by 6 to 9 percentage points, they suggest, would finance generic drug coverage in the doughnut hole with up to $10 co-pay for each monthly prescription, thus providing needed protection to seniors who would otherwise face a gap in coverage.

Source: University of Pittsburgh Schools of the Health Sciences

Explore further: Can YouTube save your life?

add to favorites email to friend print save as pdf

Related Stories

Apple sends out invites to Sept. 9 event

23 minutes ago

Apple on Thursday sent out invitations to an event on September 9 near its Silicon Valley headquarters, amid rumors the tech giant will unveil a new iPhone and maybe a wearable device.

New type of cell movement discovered

26 minutes ago

For decades, researchers have used petri dishes to study cell movement. These classic tissue culture tools, however, only permit two-dimensional movement, very different from the three-dimensional movements ...

Watching the structure of glass under pressure

28 minutes ago

Glass has many applications that call for different properties, such as resistance to thermal shock or to chemically harsh environments. Glassmakers commonly use additives such as boron oxide to tweak these ...

Recommended for you

Can YouTube save your life?

6 hours ago

Only a handful of CPR and basic life support (BLS) videos available on YouTube provide instructions which are consistent with recent health guidelines, according to a new study published in Emergency Medicine Australasia, the jo ...

Doctors frequently experience ethical dilemmas

7 hours ago

(HealthDay)—For physicians trying to balance various financial and time pressures, ethical dilemmas are common, according to an article published Aug. 7 in Medical Economics.

AMGA: Physician turnover still high in 2013

7 hours ago

(HealthDay)—For the second year running, physician turnover remains at the highest rate since 2005, according to a report published by the American Medical Group Association (AMGA).

Obese or overweight teens more likely to become smokers

8 hours ago

A study examining whether overweight or obese teens are at higher risk for substance abuse finds both good and bad news: weight status has no correlation with alcohol or marijuana use but is linked to regular ...

Taking preventive health care into community spaces

9 hours ago

A church. A city park. An office. These are not the typical settings for a medical checkup. But a new nationwide study by the UCLA Center for Health Policy Research shows that providing health services in ...

User comments : 0