Medicare Prescription Drug Benefit 'Doughnut Hole' Prompts Many Beneficiaries To End Treatment With Medications

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Compliance
Article Date: 20 Oct 2008 - 4:00 PDT

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BusinessWeek on Wednesday examined how many Medicare beneficiaries enrolled in the prescription drug benefit do not take necessary medications after they reach the "doughnut hole" coverage gap, in which they must cover the full cost of their treatments. According to an analysis released by the Kaiser Family Foundation in August, 26% of Medicare beneficiaries who filled any prescriptions under the prescription drug benefit, or about 3.4 million, reached the coverage gap in 2007. The analysis also found that 15% of Medicare beneficiaries enrolled in the prescription drug benefit who were taking drugs for a variety of chronic diseases did not take their medications after they reached the coverage gap.

Tricia Neuman, a Kaiser Family Foundation vice president and director of the Medicare Policy Project at the foundation, said, "High drug costs are a barrier, but this is the first time we're seeing it documented so plainly," adding, "This raises concerns about the consequences for people with serious chronic conditions." Carolyn Clancy, director of the Agency for Healthcare Research & Quality, said, "There is a growing recognition that the doughnut hole is impairing people's access to medications."

Health care policy experts "believe that the next administration will be under pressure to address the doughnut hole, and both candidates have expressed some support for reforming" the Medicare prescription drug benefit, BusinessWeek reports. Democratic presidential nominee Sen. Barack Obama (Ill.) has proposed to allow the federal government to negotiate directly with pharmaceutical companies for discounts on medications under the Medicare prescription drug benefit, and Republican presidential nominee Sen. John McCain (Ariz.) has proposed that higher-income beneficiaries pay higher premiums under the program (Weintraub, BusinessWeek, 10/15).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.  All rights reserved.

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