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Senior Citizens Reduce or Stop Medications Facing
Gap in Drug Coverage
Aug. 25, 2004 - Seniors who use up their yearly
drug benefits before the end of the year often resort to reducing their
recommended dosages, or even stop taking their medications altogether--a
situation that could endanger their health, according to a new study.
In a study of 1308 seniors with a yearly cap on
drug benefits, 24 percent of seniors who used up their benefit
two-and-a-half to six months before the end of the year said they used
less of, stopped, or did not start at least one of their medications
because of the out-of-pocket costs. Among the 10 medications most
affected were those drugs for treating high cholesterol, hypertension,
asthma, depression, and pain. Two-thirds of seniors who faced this gap
in drug coverage said that it was difficult to pay for their
medications. Nearly one in four experienced difficulty paying their rent
and bills because of these costs.
This study illustrates what could happen to seniors
who fall into the "donut hole" in the new $410 billion national Medicare
drug benefit. Seniors initially pay only 25 percent of medication costs,
but there's a "donut hole" between $2,250 and $5,100 when they have no
coverage. Other studies estimate that 42 percent of Medicare
beneficiaries, many of them with chronic diseases, will be affected by
this gap in coverage.
This study is also relevant to the 4.6 million
seniors who are currently enrolled in Medicare managed care. These
health plans often are able to offer drug benefits by placing an annual
dollar "cap" on drug benefits. Members who spend past this cap, like
seniors in the study, face a "donut hole" because they pay for
medications out-of-pocket until new drug benefits kick in the following
year.
"We found that patients were making some pretty big
financial trade-offs between paying rent or buying food and purchasing
medications so they could cover their drug costs," said Dr. Carol M.
Mangione, senior study author and professor of general internal medicine
and health services research at the David Geffen School of Medicine at
UCLA "Low income seniors with serious chronic conditions such as
diabetes and hypertension are likely to have the greatest problems
covering their share of medication costs. Given the huge annual
inflation in drug costs, health plans are already hard pressed to
provide drug benefits for persons with Medicare. Doctors can help
patients make the most of their benefits or keep them from exceeding the
cap by identifying when less expensive but potentially effective
medications such as generics are appropriate."
The study, "Cost-Lowering Strategies By Medicare
Beneficiaries Who Exceed Drug Benefit Caps and Have a Gap in Drug
Coverage," is published in the August 25 issue of the Journal of the
American Medical Association.
The study surveyed 1308 seniors in 2002, half of
whom exceeded their cap in 2001 and had a gap in coverage for
two-and-a-half to six months. The other half of participants had a
higher benefit cap and coverage year-round. The researchers found that
24% of seniors who had a gap in coverage decreased their use of
medications, compared to 16% of seniors who had year-round coverage.
Many of the study participants called pharmacies for lowered prices
(46%), asked doctors for samples (34%) or switched to lower cost
medications (15%). Researchers were surprised that so many seniors with
coverage year-round were also decreasing their medication use because of
cost. In fact, one in three seniors who had coverage year-round said
paying for medications was difficult.
"This study sends out an emergency signal to
doctors that we need to be aware that seniors often only get a fixed
amount of money from their health plans to cover their medications for
the year," said Dr. Chien-Wen Tseng, the study's principal investigator
and assistant professor of family medicine and community health at the
John A. Burns School of Medicine at the University of Hawaii "Do we
really want to use it up on a heartburn or allergy medication? We can
also help by thinking twice when writing a prescription. We need to
offer patients more choices if there's a less expensive drug that might
also be just as good."
This will require a new way of thinking by
physicians,. Tseng said. "Instead of saying 'this drug is OK because
your insurance will cover it', we need to think 'this drug may cost $60
per month. That's $720 per year. How much drug benefit does my patient
have for the year?' If we don't ask these questions, a lot more of our
patients will be choosing between going to the pharmacy or the grocery
store."
In addition to Mangione and Tseng, other
researchers in the study included Robert H. Brook, professor of
geriatrics and director of UCLA's Clinical Scholars Program; W. Neil
Steers, visiting assistant resident of general internal medicine and
health services research at UCLA; and Emmett Keeler of the Rand Corp.
This study was carried out while Tseng was a Robert Wood Johnson
Clinical Scholar at UCLA with Mangione as her advisor.
The Robert Wood Johnson Foundation Clinical
Scholars Program and the American Academy of Family Physicians funded
the study.
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