New research shows that the Medicare drug plan “doughnut hole” seriously endangers not only the pocketbook, but also the health of our nation’s seniors and other Medicare enrollees. Two separate studies released this month show that patients who reach the coverage gap are more likely to stop taking their medication than they are to switch to a cheaper drug: the Public Library of Science published Changes in Drug Utilization During a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap, and the Kaiser Family Foundation Program on Medicare Policy published Understanding the Effects of the Medicare Part D Coverage Gap in 2008 and 2009.
The putative reason for the coverage gap is that the threshold will teach consumers to be aware of drug costs. Jennifer Polinski, ScD, MPH, the author of PLoS study says, “there is an expectation that people will seek less expensive drug options when they enter the donut hole.” However, these studies reveal that this is clearly not the case. Research from 2006 and 2007 shows that beneficiaries were 40% less likely to switch a drug if they did not receive financial assistance, as opposed to those beneficiaries who did. Likewise, the Kaiser study reveals that about 3.4 million, or 12%, of Part D enrollees who reached the gap in 2008 and 2009 discontinued their medication.
While these findings are disturbing, they are not all that surprising. Only 3% of those who reach the doughnut hole will get out of it – meaning that the majority remains paying for their drugs until the New Year. Faced with that daunting and expensive task, some patients prefer to wash their hands of the problem, rather than attempt to navigate a fix; others simply cannot afford their needed medication at all.
Optimistically, the studies show that a change is coming this year. Now patients who reach the doughnut hole will receive a 50% discount on brand name drugs and 7% on generic drugs, so although still footing the bill, these costs will be much lower. Let’s hope they are low enough to dissuade consumers from discontinuing their drugs, and putting their lives in danger.
