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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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