Study: Medicare coverage gap is forcing seniors to skip their meds

We’ve written here frequently about the “doughnut hole” in Medicare Part D. This is a coverage gap that, in 2009, requires seniors to begin paying full price for their prescription drugs if they exceed $2,700 in total drug costs.

Contrary to what many seniors believe, the $2,700 isn’t based on out-of-pocket expenditures, but the total cost of their drugs, including the covered portion. So a senior will typically pay less than $1,000 out of pocket before hitting the coverage gap.

And here’s where the doughnut hole becomes a chasm. Coverage doesn’t kick in again until the senior has paid a whopping $4,350 out of pocket.

About a quarter of Medicare Part D enrollees — more than six million seniors — fell into the doughnut hole in 2008.

Now a new study says that many Medicare recipients are choosing not to take their prescription medications once they hit the gap. According to researchers at the University of Pittsburgh Graduate School of Public Health, seniors reduced their monthly prescription drug purchases by 14 percent when their coverage went away.

Doctors fear that patients with chronic conditions such as diabetes and hypertension are putting their health at risk by not taking needed medications.

Clearly, something needs to be done. Unfortunately, the Medicare Part D plan is so expensive — because the legislation that created it was basically drafted by the pharmaceutical industry — that simply throwing more money at the program is not the best solution. What needs to be done first is to pass legislation allowing Medicare to negotiate drug prices with Big Pharma (just as the Veterans Administration does). That would reduce the government’s costs sufficiently to close the coverage gap altogether.

You can read a helpful primer on the doughnut hole, featuring 2009 numbers, here.

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Comments (3)

To control the pain we must first go to the doctor because we can give him what is appropriate and what we need, such as oxycodone that I take is a medicine used to counter the pain of my back pain for years, but This was the prescribing doctor, I take it in moderation because I read in findrxonline.com is a pill that causes anxiety, and if you can not control it can affect your nervous system, we must always know what the physician and thus avoid setbacks …

I am hoping that Obama will push for the rehauling of the healthcare system that he says is needed. Something needs to be done before none of us will be able to afford what we need.

I totally agree, I worked for one of the largest pharmacy benefit organizations in the country on a speciality drug and in many cases patients would hit the coverage gap in the 1st month. I can tell you that these PBM’s that are out there do not care about patients, they only care about the almighty dollar. It is irrevelant that people go without medication or that they exhaust all of their savings in no time. Social Security does offer assistance to some, but you better not have a 401K or any kind of savings, or be fortunate enough to have a pension (we all know they pay us so much), because either one of them will disqualify you. It is obvious to me that the pharmacy industry had to design these laws of the coverage gap because they probably can afford to pay out $4400 every year, but the average person can not. It’s a terrible thing that people (human beings that are in pain) have to go without medication because of a stupid insurance company.

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