Medicare beneficiaries reaching 'Doughnut Hole' stage devoid of adequate medication

Pittsburgh, February 4: Health care plan, ‘Doughnut Hole’, meant for extending better health facilities for the American seniors, seems to be failing in its objective to provide adequate coverage, raising serious health concerns.

The new study reveals that U.S. seniors, who reach the no-coverage ‘doughnut hole’ in the Medicare Part D drug plan, feel compelled to cut their prescription drugs.

According to a team of researchers at the University of Pittsburgh Graduate School of Public Health, the plan results in increased costs that have to borne on hospitalizations and physician visits due to inadequate drug coverage.

Prescription use falls considerably as patients reach their benefit caps. The results of the study indicate that Medicare Part D beneficiaries cut back on prescription drugs by 14 percent after reaching ‘Doughnut Hole’ coverage gap.

The study is published in the Feb. 3 issue of policy journal Health Affairs, online.

The Medicare drug plan makes an initial deduction of $250 for prescriptions, followed by a 25 percent copayment until the beneficiaries reach $2,250 in payments.

Medicare Part D coverage plan came into effect in January 2006. Since its inception, “there have been few studies to tell us what happens to beneficiaries once they enter the doughnut hole,” said the study's lead author, Yuting Zhang, Ph.D., assistant professor of health economics at the University of Pittsburgh Graduate School of Public Health.

For the study, Dr Zhang and colleagues examined the drug buying habits of more than 11,000 Medicare beneficiaries.

The research cautions that American seniors discontinue taking medications for chronic health problems including high blood pressure and diabetes as soon as they exceed spending limits in their Medicare prescription drug plan. The study also found that seniors in capped plans who spent the most on drugs were more likely to discontinue their medications than those in plans with no cap.

“Our findings raise concerns about whether people with chronic illnesses who lack doughnut hole coverage are able to effectively manage their conditions,” said Dr. Zhang. “Without needed prescriptions, we could potentially see an increase in hospital and physician costs.”

Once a senior falls into the trap of the doughnut hole, chances are that nearly half of them never get out simply because they find it difficult to pay for their prescription drugs in addition to the monthly premiums for a benefit they are not receiving.

It seems the care made available by the government for the benefit of the seniors is the most expensive care which could actually force them to abruptly discontinue their medicines. It could also force them to hospitals to either get their drugs or to recover from the health effects of discontinuing their medicines.

“One can assume not only that the lack of coverage in the doughnut hole had adverse health consequences but also that it could have increased costs for hospital and physician services,” the report states.

To offset the decreased use of medications among the seniors and to protect their well-being, adding coverage for generic drugs during the ‘doughnut hole’ as part of the Medicare prescription drug benefit seemed to be an imminent solution, the study pointed out.