Across eight classes of drugs examined--used to treat a variety of relatively common chronic conditions--15 percent of Medicare Part D enrollees who reached the “doughnut hole” in 2007 stopped their drug therapy for that condition, 5 percent switched to another medication in the class, and 1 percent reduced the number of drugs they were taking in the class. Those were among the findings reported in a new Kaiser Family Foundation study of Part D prescription drug utilization, The Medicare Part D Coverage Gap: Costs and Consequences in 2007.
The study finds that 26 percent of Part D enrollees who filled any prescriptions in 2007 reached the coverage gap. Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan. For example, 64 percent of enrollees taking medications for Alzheimer’s disease reached the coverage gap in 2007, as did 51 percent of those taking oral antidiabetic medications and 45 percent of patients on antidepressants. (These percentages are among Part D plan enrollees who did not receive low-income subsidies.)
Beneficiaries who reached the coverage gap faced substantial increases in out-of-pocket spending. For example, among Part D enrollees who reached the coverage gap, but did not receive catastrophic coverage, average monthly out-of-pocket costs nearly doubled from $104 prior to the coverage gap, to $196 in the “doughnut hole.” The vast majority (84 percent) of the Part D enrollees who reached the coverage gap did not have sufficient additional drug spending during the year to receive catastrophic coverage, at which point their Part D plan would pay 95 percent of drug costs. Download the report.
