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Medicare Drug Program News
Senior Citizens May Stop Taking Critical Medicine
When They Hit Doughnut Hole
Study finds they may not restart when the drug
coverage resumes
 Sept. 11, 2007 - Many senior citizens may just stop
taking important drugs for chronic illnesses, such as diabetes and high
blood pressure, when they fall into the Medicare drug programs “doughnut
hole” or reach spending limits in other drug plans. What is additionally
disturbing is that many may not restart these life-saving drugs when
their plan coverage restarts.
The RAND Corporation study, which examined the
behavior of seniors enrolled in a national private health plan, provides
insight into how seniors may act under provisions of Medicare’s new drug
benefit plan that will leave about one-third of enrollees without drug
coverage for some part of each benefit year.
“Prescription use falls significantly as patients
reach their benefit caps,” said Geoffrey Joyce, the study’s lead author
and a senior economist at RAND, a nonprofit research organization. “Most
of the drugs we studied help prevent long-term complications of chronic
disease so there are likely to be adverse health consequences for
seniors who hit their caps.”
The study issued today says that even when drug
benefits resume at the start of a new health plan year, a significant
number of seniors do not resume their prescription medications. These
findings are published in the September/October edition of the journal
Health Affairs.
RAND Health researchers studied prescription drug
use from 2003 to 2005 among more than 60,000 people enrolled in a health
plan offered to retirees by a large national employer. Enrollees had a
choice of two drug plans that offered annual drug benefit caps of $1,000
or $2,500 and one drug plan that had no spending limit. Participants had
to pay a portion of individual drug purchases in each of the plans.
The study examined enrollees’ use of drugs used to
treat high blood pressure, drugs that target cardiac problems, diabetes
drugs, ulcer treatments and antidepressants. They also studied
prescription pain medications that have over-the-counter substitutes.
About 6 percent to 13 percent of the people
enrolled in drug plans with caps reached their spending limits in each
of the years studied, with about half the affected enrollees going
without benefits for more than 90 days, according to the study.
High spenders in the capped plans were more likely
to discontinue use of their medications than people enrolled in the plan
with no spending limits, according to researchers. Discontinuation rates
differed by type of drug, ranging from 15 percent for anti-cholesterol
medication to 28 percent for cardiac drugs. Rates were higher for pain
medications and anti-ulcer drugs where over-the-counter alternatives
were available.
Researchers say they were surprised that more
people did not switch to generic drugs, given they are generally cheaper
than name-brand medications. While people were less likely to quit using
generic drugs once they reached benefit caps, no widespread move to the
lower-cost alternatives was noted.
Among patients who stopped taking a medication in
the capped plan, more than half did not restart their prescriptions
during the first three months after benefits resumed.
“Given the importance of these drugs, it’s
distressing that the resumption rates are not higher,” said Dana
Goldman, the study’s senior author and director of health economics at
RAND. “Drug caps are a cost-saving measure, but our findings raise the
issue of whether in the long run they may lead to other medical costs
such as increased hospitalizations.”
Researchers said the study may help guide
policymakers who are concerned with the so-called “doughnut hole” in
Medicare prescription drug plans. Spending limits contained in the
Medicare drug plan are expected to leave between 24 percent and 38
percent of enrollees without drug coverage for part of each benefit
year.
“Caps on prescription drug spending are not a
prudent way to restrict costs,” Joyce said. “Cycling in and out of
coverage is likely to have adverse health effects over time.”
Editor’s Notes:
Other authors of the study are Pinar Karaca-Mandic
and Yuhui Zheng of RAND.
Support for the study was provided by the National
Institute on Aging through its support of the RAND Roybal Center for
Health Policy Simulation and the Bing Center for Health Economics.
RAND Health, a division of the RAND Corporation, is
the nation's largest independent health policy research program, with a
broad research portfolio that focuses on health care quality, costs and
delivery, among other topics.
The RAND Corporation is a nonprofit research
organization providing objective analysis and effective solutions that
address the challenges facing the public and private sectors around the
world.
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