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Medicare Prescription Drug Benefit Shows Mixed Results

More getting drugs they need, but sickest still going without, study finds

TUESDAY, April 22 (HealthDay News) -- The Medicare Part D benefit has resulted in some improvements for seniors but no real revolution in prescription drug adherence.

A new report finds that Medicare beneficiaries are less likely to forego basic needs such as food to pay for medicine, but the sickest patients are still skipping meds due to burdensome costs.

"It's a mixed picture. We saw some things to be happy about and others to be concerned about," said study author Jeanne Madden, an instructor in the department of ambulatory care and prevention at Harvard Medical School in Boston. "Although this is the third year [of the program], the good data is just starting to come to the surface. It bears a lot of additional scrutiny."

Madden's study is in the April 23/30 issue of the Journal of the American Medical Association.

"This study reveals that the federal government has more work to do to assure that the Medicare Part D program meets the needs of the most vulnerable Medicare beneficiaries," Gail Shearer, director of health policy analysis at Consumers Union, said in a statement. "It is unacceptable that the sickest beneficiaries may not be filling prescriptions or taking the full doses or courses of their medicines because they simply can't afford to."

Medicare Part D, which provides drug benefits, took effect in January 2006. More than half of Medicare beneficiaries have enrolled in the program. Some 10 percent of beneficiaries still have no drug coverage, compared to up to 38 percent before the program took effect.

Surveys have shown that without adequate prescription drug benefits, seniors tend to skip doses, reduce doses or leave prescriptions unfilled. This, in turn, can result in serious health outcomes, including even heart attack and stroke.

Madden and her team looked at survey responses from 24,234 Medicare beneficiaries to determine how Medicare Part D had changed cost-related adherence to drug regimens.

In 2004 and 2005, before Part D, 15.2 percent and 14.1 percent of beneficiaries, respectively, skipped pills because of cost, versus 11.5 percent in 2006, after the program was implemented.

Similarly, in 2004 and 2005, 10.6 percent and 11.1 percent of beneficiaries, respectively, skimped on basic needs so as to be able to pay for medications, a percentage which declined to 7.6 percent in 2006.

The sickest individuals continued to skip pills at about the same rate both before and after Part D, although they were less likely to forego basic necessities. These beneficiaries are more likely to falling into the "donut hole," when drug costs are between $2,250 and $5,100, individuals have to pay the full cost of their drugs.

"This places a lot of burden on the sickest patients," Madden said. "[But] those sicker people aren't the only ones who are going to fall into the gap. The structure of that is pretty harsh. There's no coverage whatsoever for several thousand dollars."

A second study appearing in the same issue of the journal found that not only did Medicare beneficiaries enrolled in Part D still skip doses or switch to cheaper drugs, many do not understand the program.

The findings, conducted by researchers at Kaiser Permanente Medical Care Program in Oakland, Calif., were based on telephone interviews with about 1,000 Medicare beneficiaries in Northern California.

Only 40 percent of respondents knew that the new drug plan had a coverage gap (the "donut hole"). Thirty-six percent of respondents reported at least one cost-coping behavior. These behaviors were more common in households with lower incomes.

More information

Visit Consumer Reports for a free guide to prescription drugs.

SOURCES: Jeanne Madden, Ph.D., instructor, department of ambulatory care and prevention, Harvard Medical School, Boston; statement, Gail Shearer, Director of Health Policy Analysis, Consumers Union; April 23/30, 2008, Journal of the American Medical Association

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