Seniors skip drugs when paying out of pocket

A new study of Medicare prescription drug benefits finds that a gap in coverage — called the donut hole — leads to smaller annual drug costs. The problem is that part of the savings are coming from seniors skipping their medications.

A new study of Medicare prescription drug benefits finds seniors who have a gap in coverage — called the donut hole — pay less in annual drug costs. But part of the savings are coming from seniors skipping their medications.

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The so-called donut hole of Medicare’s drug coverage means that people who have a lot of prescriptions, or very expensive ones, may exceed their benefits and end up having to pay out of pocket.

Vicki Fung at Kaiser Permanente is one of the analysts on the study. She says people with a coverage gap paid less for drugs annually.

Fung: But at least some of these cost savings were because beneficiaries with a gap had reduced their use of chronic medications … including diabetes, hypertension and cholesterol drugs. So this raises the potential of adverse health outcomes.

Fung says that up to eight percent more people skipped their medications when their plan included a donut-hole.

Fung: These reductions in adherence do raise concerns about potential unintended clinical effects, especially given previous studies that have found higher rates of hospitalization and deaths with similar rates of reduction in adherence.

Richard Stefanacci is a professor at the University of the Sciences in Philadelphia – and he was not involved in this study. He says the results confirm what was already known — that the more people have to pay for drugs, the fewer they take.

Stefanacci: It doesn’t matter what the disease is, as far as adherence. It could be as devastating as cancer or diabetes patients whenever the out of pocket goes up tend to be less adherent, irregardless of disease state.

Health reform legislation aims to shrink the donut hole by covering half the cost of brand name drugs during the out-of-pocket period. Stefanacci says it will help, but only go half-way to getting people to stick to their prescriptions.