Sickest patients still struggle under new Medicare Part D benefit

April 22, 2008

BOSTON, Mass. (April 22, 2008)--A recent study finds that the advantages of the new Medicare Part D drug benefit--a program that for the first time offers Medicare recipients prescription drug coverage--are mixed. On the one hand, both healthy and sick beneficiaries are now less likely to cut back on basic necessities (e.g., food) in order to pay for medicine. However, the sickest patients, who typically have high drug expenditures, are still skipping medications for financial reasons--despite the new benefit.

The study, which appears in the April 23 issue of the Journal of the American Medical Association (JAMA), was based at the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care.

"We're seeing encouraging signs of relief, but the problem of unmanageable drug costs has by no means been eliminated," says Harvard Medical School instructor and lead author Dr. Jeanne Madden. "Medicare Part D is a work in progress, and more needs to be done to ensure that very sick individuals get the drugs they need."

This is the first nationwide study to examine the effect of the Medicare Part D drug benefit on financial hardship since the benefit took effect in January 2006. The new benefit represented the largest expansion of the Medicare program since enactment in 1965. Over half of Medicare beneficiaries enrolled in Part D, which was intended to increase access to needed medications, especially among the poor and chronically ill. About 10 percent of beneficiaries still have no drug coverage. Other reports have estimated that about 30% of beneficiaries had no drug coverage prior to Part D.

The investigators examined survey responses from 24,234 Medicare enrollees who participated in the Medicare Current Beneficiary Survey from 2004 through 2006. Over 72 percent of the beneficiaries had two chronic illnesses or more. The Centers for Medicare and Medicaid Services conducts this national survey to collect detailed information on health and health care experiences.

The study found that the rate of skipping pills and prescriptions due to cost declined from 14.1% of beneficiaries in 2005 to 11.5% in 2006. Spending less on basic needs to afford medicine declined from 11.1% to 7.6% over the same period.

But the sickest patients, who skipped pills at about twice the rate of healthier patients in 2004 and 2005, experienced no improvements in pill-skipping after Part D began in 2006, even though they were less likely to cut back on basic necessities to pay for medicine after Part D.

Previous studies have shown that Medicare beneficiaries in poor health with high out-of-pocket drug expenses have considerable difficulty paying for medications and often take less medicine than directed or don't fill prescriptions. Skipping pills can lead to preventable and costly hospitalizations. Sicker beneficiaries are also more likely to encounter the coverage gap, sometimes called the "doughnut hole," a peculiar feature of the Part D benefit. During 2006, once a beneficiary's drug expenses reached $2,250, they had to pay the full cost of their medications until their expenses hit $5,100, at which point Medicare covered 95% of their drug expenses. (As of 2008 the gap is between $2510 and $5726.)

"Plugging the doughnut hole is a first step to reduce pill-skipping among the sickest patients," says Harvard Medical School professor Stephen Soumerai, the principal investigator on the study. "Such coverage gaps cut off access to life-saving drugs. The new administration should also work harder to enroll the three to four million people who are eligible for low-cost coverage but are still without coverage, and also examine whether out-of-pocket spending under Part D is just too high for chronically ill people with extensive medication needs."
-end-
This study was funded by the National Institute on Aging and the Harvard Pilgrim Health Care Foundation.

Full citation:

Journal of the American Medical Association (JAMA), April 23 2008,Vol. 299 No. 16; 1922-1928
"Cost-Related Medication Nonadherence and Spending on Basic Needs Following Medicare Part D"
Jeanne M. Madden, PhD,(1) Amy J. Graves, MPH,(1) Fang Zhang, PhD,(1) Alyce S. Adams, PhD,(1) Becky A. Briesacher, PhD,(2) Dennis Ross-Degnan, ScD,(1) Jerry H. Gurwitz, MD,(2) Marsha Pierre-Jacques, BA,(1) Dana Gelb Safran, ScD,(3) Gerald S. Adler, MPhil,(4) Stephen B. Soumerai, ScD,(1)

(1) Harvard Medical School and Harvard Pilgrim Health Care;
(2) Meyers Primary Care Institute and University of Massachusetts Medical School;
(3) Tufts University School of Medicine and Blue Cross Blue Shield of Massachusetts;
(4) Centers for Medicare and Medicaid Services

Harvard Medical School (http://hms.harvard.edu/hms/home.asp) has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

Harvard Pilgrim Health Care (http://www.hphc.org) is a not-for-profit health care plan operating in Massachusetts, New Hampshire, and Maine with a network of more than 22,000 doctors, 135 hospitals, and more than 970,000 members. Harvard Pilgrim was the first New England health plan to establish a nonprofit foundation with the sole purpose of serving the community at large. The efforts of the foundation reflect Harvard Pilgrim's mission, which is to improve the health of its members and the health of society.

Harvard Medical School

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.