A recent study finds that the results of the new Medicare Part D drug benefit—a program that for the first time offers Medicare recipients prescription drug coverage—are mixed. Both healthy and sick beneficiaries are now less likely to cut back on basic needs like food in order to pay for medicine. The sickest patients, however, who typically have high drug expenditures, are still skipping medications for financial reasons—despite the new benefit.
The study, which appears in the April 23 Journal of the American Medical Association, was based at the Department of Ambulatory Care and Prevention at HMS and Harvard Pilgrim Health Care.
“We’re seeing encouraging signs of relief, but the problem of unmanageable drug costs has by no means been eliminated,” said lead author Jeanne Madden, an HMS instructor in ambulatory care and prevention. “Medicare Part D is a work in progress, and more needs to be done to ensure that very sick individuals get the drugs they need.”
This is the first nationwide study to examine the effect of the Medicare Part D drug benefit on financial hardship since the benefit took effect in January 2006. The new benefit was the largest expansion of the Medicare program since enactment in 1965. More than half of Medicare beneficiaries enrolled in Part D, which was intended to increase access to needed medications, especially among the poor and chronically ill. About 10 percent of beneficiaries still have no drug coverage. Reports have estimated that about 30 percent of beneficiaries had no drug coverage prior to Part D.
In the current study, the investigators examined responses from 24,234 Medicare enrollees who participated in the Medicare Current Beneficiary Survey from 2004 through 2006. More than 72 percent of the beneficiaries had at least two chronic illnesses. The study found that the rate of skipping pills and prescriptions due to cost declined from 14.1 percent of beneficiaries in 2005 to 11.5 percent in 2006. Spending less on basic needs to afford medicine declined from 11.1 percent to 7.6 percent over the same period.
But the sickest patients, who skipped pills at about twice the rate of healthier patients in 2004 and 2005, experienced no improvements in pill-skipping after Part D began, even though they were less likely to cut back on basic necessities to pay for medicine after Part D. This group was more likely to encounter the benefit’s coverage gap, sometimes called the “doughnut hole,” a peculiar feature of Part D. During 2006, once a beneficiary’s drug expenses reached $2,250, he had to pay the full cost of his medications until his expenses hit $5,100, at which point Medicare covered 95 percent of drug expenses. (As of 2008, the gap is between $2,510 and $5,726.)
“Plugging the doughnut hole is a first step to reduce pill-skipping among the sickest patients,” said the study’s principal investigator, Stephen Soumerai, an HMS professor of ambulatory care and prevention. “Such coverage gaps cut off access to life-saving drugs.”
