Diabetes Drugs Fell in the Doughnut Hole

The gap in Medicare prescription drug coverage, or the doughnut hole, may be why many seniors with diabetes are not adhering to medications. Researchers from Kaiser Permanente and the David Geffen School of Medicine at the University of California, Los Angeles, focused their study on what happens during the gap, or when patients are paying for their medications out of pocket.¹

Using data from 2006, the researchers looked at adherence to diabetes medications among participants in 2 large health systems that offered Medicare Part D plans. Patients were considered adherent if they filled 80% of their prescriptions for diabetes medications. In 2006, the Medicare Part D plan was structured so that the first $2250 was paid by the plan and the patient (in the form of copayments and deductibles); after that, the patient had to pay a total of $3600 in out-of-pocket expenses for the year before the plan would again start covering medication costs.

Results of the study showed that patients with a gap in coverage had lower total diabetes medication costs but higher out-of-pocket expenses and lower rates of adherence than patients who had a supplemental prescription drug benefit. According to study author Vicki Fung, PhD, the finding of lower total drug costs was in part a result of patients skipping doses of medication, ultimately leading to poorer outcomes and, subsequently, higher total health care costs.

References:

Reference
1. Fung V, Mangione CM, Huang J, et al. Falling into the coverage gap: Part D drug costs and adherence for Medicare Advantage Prescription Drug Plan beneficiaries with diabetes. Health Serv Res. 2009 Dec 30; [Epub ahead of print].