Medicare Donut Hole Leads to Drop off in Drug
Therapy for High Cholesterol Patients
Generics use improves compliance; enrollees reach the
gap in significant numbers by early summer
Sept.
25, 2008 - Senior citizens battling high cholesterol are more likely to
stop taking their medications once they reach the Medicare Coverage Gap,
better known as the Donut Hole, a result that may put them at higher
risk for heart attack and stroke. The study by Medco Health Solutions
also found the seniors 20 percent less likely to stop the treatment if
they were taking generic drugs.
The study finds that Medicare beneficiaries
prescribed cholesterol lowering statins are nearly twice as likely to
abandon their cholesterol-fighting medications when they reach the
Coverage Gap, or donut hole, and become responsible for paying the
entire cost of their medications, than they are in the initial phase of
the benefit when the cost of the medication is covered.
Studies show that these medicines - known as
statins - significantly reduce the risk of heart attack and stroke for
patients with high cholesterol.
The Medco analysis further reveals that Medicare
Part D recipients prescribed branded cholesterol-lowering statins are
most at risk since they are more likely to stop taking their medications
than those using a generic drug.
The study shows that during 2007, the rate of
patients who suspended generic statin treatment was 20 percent lower
than those on a brand-name medication.
"This research confirms the concerns related to
patient health in the Coverage Gap, and also validates the positive
impact generics have on helping patients remain compliant with their
medications," said Dr. Woody Eisenberg, chief medical officer of Medco
Retiree Solutions(TM). "Taking statins regularly can help prevent
serious cardiovascular problems, so it's important that patients remain
faithful to their therapies throughout the year. Using generics can help
seniors delay or possibly even avoid hitting the Gap and increases the
likelihood that they'll continue to take these essential medications."
According to the Medco research, which included
non-low income subsidy beneficiaries across all phases of the Medicare
benefit in 2007, 22 percent of recipients reached the Gap by July 2007
and by December 2007 exactly half were either in the Gap or had such
high costs that they had proceeded to the Catastrophic Coverage phase of
the benefit.
During 2007, the Medicare Part D Coverage Gap took
effect when beneficiaries' total drug costs reached $2,400.
Beneficiaries were then responsible for paying 100 percent of their drug
costs until total costs reach $5,451, when Catastrophic Coverage begins
to cover 95 percent of a beneficiary's drug costs.
Generic Use Surges in the Gap
The analysis also reveals that reaching the
Coverage Gap dramatically stimulates the use of generics among all
Medicare recipients. During the initial phase of the benefit, when the
plan provides drug coverage, one-third of the medications used daily by
beneficiaries were generics and two-thirds were brand-name drugs. Once
beneficiaries reached the Gap and were responsible for the full cost of
the drug, those numbers flip - generic usage rises to 71 percent and
brand-name use falls to 29 percent.
"Upon reaching the Gap, Medicare beneficiaries
become acutely aware of the cost differences between brand-name and
generic drugs and most make the switch. Unfortunately, by not using
generics in the initial phase of the benefit, they put themselves at
greater risk for hitting the Coverage Gap much faster," said Eisenberg.
The cost difference between generics and brand name
drugs for patients in the Coverage Gap can be significant. In the
initial covered phase of the benefit, the average cost of 30 days of
branded therapy of lipid-lowering medications for standard eligible
patients is $30.89 versus $7.06 for a generic. In the Coverage Gap, it
increases to $88.44 for brands and $16.14 for generics.
Bridging the Communication Gap
According to a 2008 Medco survey of 400 Medicare
beneficiaries, 78 percent of respondents said they felt that it was
important for their health plan to communicate money-saving tips to help
delay reaching the Gap. In addition, a majority of respondents indicated
that programs alerting them to their proximity to the Gap were
significant factors in their decision to re-enroll with the plan.
Recognizing the importance of educating enrollees
about the Coverage Gap, Medco has introduced a Coverage Gap
communications program that alerts its Prescription Drug Plan members
and specific health plan beneficiaries through mailings and outbound
phone calls of their proximity to the Gap long before they reach it.
Additionally, any time one of these members contacts a customer service
representative for any reason, a Coverage Gap status update is provided.
To increase the likelihood that physicians will prescribe a generic drug
rather than a brand, Medco offers members prescription forms they can
bring to their physician or contacts the doctor on the member's behalf
to discuss generic alternatives that can lower the member's costs.
Medco's specialist pharmacists, who are dedicated
to the treatment of patients with specific chronic and complex diseases
such as diabetes and heart disease, counsel members on the importance of
compliance and utilize integrated data systems to identify patients who
are not properly adhering to their medication regimens.
About Medco
Medco Health Solutions, Inc. (NYSE:MHS)
is the nation's leading pharmacy benefit manager based on its 2007 total
net revenues of more than $44 billion. Medco's prescription drug benefit
programs, covering approximately one-in-five Americans, are designed to
drive down the cost of pharmacy health care for private and public
employers, health plans, labor unions and government agencies of all
sizes, for individuals served by the Medicare Part D Prescription Drug
Program, and those served by Medco's specialty pharmacy segment, Accredo
Health Group. Medco, the world's most advanced pharmacy(R), is
positioned to serve the unique needs of patients with chronic and
complex conditions through its Medco Therapeutic Resource Centers(R),
including its enhanced diabetes pharmacy care practice through the
Liberty acquisition. Medco is the highest-ranked independent pharmacy
benefit manager on the 2008 Fortune 100 list. On the Net:
http://www.medco.com/.
