HFMA NEWS

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.

A comprehensive new Kaiser Family Foundation survey of the experiences of New Orleans residents--the second since Hurricane Katrina--reveals a still-struggling population that gives very mixed reviews in key areas of the recovery efforts. In two critical areas, housing (72 percent) and crime (71 percent), the majority of city residents see little or no progress. In other key areas--medical facilities, public schools, jobs, and rebuilding neighborhoods--reviews are more mixed, but with majorities seeing little or no progress. Only in one area, levee repair, does a majority (60 percent) see progress.

In health-related issues, the survey finds a substantial deterioration in residents’ self-reported mental health status. Currently, 15 percent of residents say they have been diagnosed with a serious mental illness such as depression, up from 5 percent in 2006. And 65 percent report either having some sort of chronic condition or disability or being in “fair” or “poor” health, up from 45 percent in 2006.

However, more residents report having health insurance coverage (with 18 percent saying they are uninsured, down from 26 percent in 2006), and fewer say that they do not have a usual source of health care or primarily depend on a hospital emergency department (25 percent, down from 34 percent). At the same time, the affordability of care appears to be a bigger issue. Overall, 25 percent say they had a problem paying for medical bills in the past six months, up dramatically from 9 percent in 2006. Access the report.