Navigation Links
Medicare Drug Plan 'Doughnut Hole' Could Impact Seniors' Health

Lack of coverage can spur cutbacks in necessary prescriptions, study finds

TUESDAY, Feb. 3 (HealthDay News) -- American seniors who reach the no-coverage "doughnut hole" in the Medicare Part D drug plan are less likely to use prescription drugs than those with an employer-based plan, a new study finds.

The finding raises concerns about health consequences and increased costs from hospitalizations and doctor visits resulting from this lack of drug coverage, say researchers at the University of Pittsburgh Graduate School of Public Health.

A change in policy that would mandate the coverage of generic drugs in the doughnut hole through a modest increase in initial prescription co-payments could help protect seniors, the team suggested.

The doughnut hole in Medicare Part D begins when a person's annual individual drug expenditures reach a certain amount, pegged at $2,250 in 2006. Coverage begins again when those expenses reach the "catastrophic" phase of coverage, which was $5,100 in 2006.

The University of Pittsburgh team compared two groups of seniors with Medicare drug coverage provided by a large Pennsylvania insurer in 2006. One group was covered through Medicare Advantage prescription drug plans (MA-PD) with either no doughnut hole coverage or generic coverage only. The other group was covered through more generous employer-sponsored plans with full coverage in the doughnut hole.

One in four (25 percent) of those enrolled in MA-PD reached the doughnut hole, the researchers reported, but only 5 percent of that group reached the catastrophic phase of coverage.

Those who lacked coverage in the doughnut hole reduced their monthly prescriptions by 14 percent once they entered the doughnut hole, compared to only 3 percent of those with generic coverage in the doughnut hole. The researchers saw no reduction in prescriptions for those with employer-based plans.

Those with diabetes were more likely to reach the doughnut hole, and reach it sooner, than those with hypertension. Seniors with more than one chronic illness were also much more likely than others to reach the doughnut hole -- 34 percent of those with both hypertension and diabetes reached it, as did 61 percent of those with hypertension, high cholesterol, congestive heart failure and diabetes.

The study was published online Tuesday in the journal Health Affairs.

"Our findings raise concerns about whether people with chronic illnesses who lack doughnut hole coverage are able to effectively manage their conditions. Without needed prescriptions, we could potentially see an increase in hospital and physician costs," lead author Yuting Zhang, an assistant professor of health economics, said in a university news release.

More information

The U.S. Centers for Medicare and Medicaid Services offers tips for reducing costs during the coverage gap.

-- Robert Preidt

SOURCE: University of Pittsburgh Schools of the Health Sciences, news release, Feb. 3, 2009

Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. GAO Report Confirms: Medicare Underpays for Anesthesia Services; Nurse Anesthetists Assure Seniors Access to Safe Anesthesia Care
2. Texas Supreme Court Rules Against Medicare HMOs in Hospital Reimbursement Fight
3. Owner and Operator of Florida Durable Medical Equipment Company Convicted of Medicare Fraud
4. Just Completed Studies Reveal Impact of New Medicare Reimbursement Regulations
5. AHCA: Rescinding $2.7 Billion Medicare Cuts Top Issue for Fall Legislative Agenda
6. University of Texas Study Details Lengthy Payment Delays for Medicare Part D Prescription Drug Claims, Confirming Need for Legislative Fix
7. Medicare Spending Caps Cause Seniors to Stop Meds
8. Medicare Prescription Drug Benefit, Nonprofit Hospitals, Ambulatory Surgery Centers, Statistical Methods, and Pay-For-Performance Highlighted In the Latest INQUIRY Journal
9. Medicare Every Diabetic Counts Project Gears Up for Kick-Off
10. Medicare Cuts to Physicians Will Harm Washington Seniors
11. More than 10,000 Medicare Patients in Montana Could Be Hit by Proposed Cuts to Home Oxygen Therapy; Access to Power Wheelchairs Would Also Decrease
Post Your Comments:
Related Image:
Medicare Drug Plan 'Doughnut Hole' Could Impact Seniors' Health
(Date:11/25/2015)... ... 25, 2015 , ... In an ongoing Clinical Study conducted by an independent ... UV Angel is evaluating the efficacy of its product and its disinfection protocol. This ... beds) from May 2014 through October 2015 at a 360-bed, acute-care, academic medical center ...
(Date:11/25/2015)... ... November 25, 2015 , ... "When I underwent breast reconstruction ... incredibly uncomfortable," said an inventor from Bronx, N.Y. "In order to meet my ... RECOVERY BRA for added comfort and support. The bra is easier to put ...
(Date:11/25/2015)... ... ... Since its launch in 2012, the Regenestem brand ( ... to patients with chronic degenerative medical conditions. Now, the U.S. Patent and Trademark ... Organizations are required to hold a registered trademark in order to make licensing ...
(Date:11/24/2015)... ... ... Dr. Todd S. Afferica, a noted general dentist in Norcross, GA ... Afferica now uses the BIOLASE WaterLase iPlus 2.0™ in many of his dental procedures. ... traditional cutting tools, such as the scalpel and high-speed drill, which can both cause ...
(Date:11/24/2015)... ... , ... In an article published November 12th by Obesity News ... or are not eligible for bariatric surgery. The article explains that candidates for weight ... 100 pounds overweight, or have a BMI of 35 and over with at least ...
Breaking Medicine News(10 mins):
(Date:11/24/2015)... November 24, 2015 --> ... "Spine Biologics Market by Product Type (Bone Graft, Bine Graft ... and Fusion, Posterior Lumbar Interbody Fusion), End User, and Geography ... market was valued at $1.90 Billion in 2014 and is ... of 4.4% during the forecast period of 2015 to 2020. ...
(Date:11/24/2015)... , Nov. 24, 2015 Avery Biomedical Devices ... pleased to announce the appointment of Anders Jonzon ... Dr. Jonzon is ... at Children,s Hospital, Uppsala University, Uppsala and Children,s Hospital, ... he was a fellow at the Cardiovascular Institute (UCSF). ...
(Date:11/24/2015)... 2015 . ... adds Latest Guidebook for Chinese Medical Device GMP ... in November 2015 to the medical devices market ... at . China ... global economies with a fifth population in the ...
Breaking Medicine Technology: