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CVS Caremark, Harvard and Brigham and Women's Researchers Say Medicare 'Donut Hole' Can Lead to a Decrease in Medication Adherence
Date:8/16/2011

than they are to switch to more affordable or generic drugs.  The resulting decrease in medication adherence could ultimately result in higher medical costs as a result of adverse health events."

When Congress created the Medicare Part D program in 2003, the standard benefit design included a coverage gap, known widely as the donut hole. Under the standard benefit, Medicare Part D enrollees receive financial assistance to pay for drugs until plan and out-of-pocket spending reaches an initial threshold of $2,830 (2010). At that point, the Medicare beneficiary is financially responsible for 100 percent of medication costs until they have spent more than $4,550 (2010), when the program's financial benefits begin again. The research team said of the 663,850 beneficiaries it tracked in 2006 and 2007, approximately one-third reached the donut hole seven months into the fiscal year. Other studies estimate between 11 and 14 percent of Part D enrollees who do not receive a low-income subsidy reach the donut hole each year.

"No doubt, this is a difficult area for policymakers. Taking cost out of the health care system is something everyone is trying to achieve," said Troyen A. Brennan, MD, MPH, executive vice president and chief medical officer of CVS Caremark, who heads the research initiative that conducted the study. "The Affordable Care Act incrementally eliminates the donut hole by 2020, but until that time program beneficiaries remain at risk of decreased drug utilization because of high out-of-pocket drug costs. A strategy that promotes the use of low cost medications and that keeps people adherent would result in better health outcomes and overall reduced health care costs. "

The Medicare Part D study published today is a product of a three-year research collaboration between CVS Caremark, Harvard and Brigham and Women's Hospital that is focused on understanding why many consumers do not take their prescriptions as directed, and developing
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