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.
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