Some 3.4 million Medicare beneficiaries hit the so-called doughnut hole in drug coverage last year — and a sizable minority quit taking their medicine rather than pay full price out of pocket, a new report says.

At last year’s rate, Medicare beneficiaries were on the hook for prescription drugs after they incurred costs of $2,400. After a beneficiary spent $3,850 out-of-pocket, coverage kicked in again. That coverage gap is commonly referred to as the doughnut hole. (It doesn’t apply to low-income seniors, who qualify for a subsidy.)

A report released yesterday by the Kaiser Family Foundation (online here) used data from the number-crunchers at IMS Health to figure out how many beneficiaries hit the doughnut hole, and what happened when they did.

They looked in depth at trends for several common classes of drugs, including diabetes medicines and antidepressants. They found that 15% of those who hit the doughnut hole stopped taking their medication. Another 1% cut back on their medication use, while 5% switched medications.

The doughnut hole was included in the Medicare drug benefit to save the government money, but patients who stop taking medicines for chronic conditions such as diabetes face higher risks of complications such as heart attacks. Some Medicare drug plans, which cost less than $50 a month, offer at least partial coverage through the donut hole, a Medicare spokesman told the Associated Press.

3.4 million Medicare Part D plan enrollees reached a gap in their prescription drug coverage, according to a new report from the Kaiser Family Foundation. This gap – known as the “doughnut hole” – is the period during which people with a Medicare drug plan have to pay 100% of their drug costs, which is in 2008 is more than $2700.

The Kaiser study found that more than 25% of Part D enrollees who filled any prescriptions in 2007 reached the coverage gap. Enrollees with chronic conditions such as Alzheimer’s disease, diabetes, and depression had a much higher risk of reaching the coverage gap.

Some enrollees who reach the coverage gap stop taking their medication. Looking at eight classes of medications prescribed for a variety of common health conditions, the researchers found that about 15% of Part D enrollees who reached the coverage gap stopped their medications. For example, 10% of Part D enrollees taking oral medication for the treatment of type 2 diabetes who reached the coverage gap stopped taking their medications. For a person with diabetes stopping medication for even a short period of time can cause serious and immediate health problems.

Some senior citizens with chronic conditions choose to stop taking medicines instead of paying full price for them under the federal government’s Medicare prescription drug payment system, a report Thursday found.
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The patients on Medicare — the federally funded health insurance program for seniors and those with disabilities — stopped buying their medication when they hit a coverage gap in their prescription drug plan that required them to pay full price.

When annual drug expenses for a single Medicare consumer reach $2,400, the patient enters a coverage gap known as the “doughnut hole.” From there, the consumer must pay the entire negotiated cost of their drugs until total expenses reach $5,100. Insurance coverage kicks in again afterward.

Researchers at Georgetown University and the University of Chicago working for the Kaiser Family Foundation found that about 15 percent of the 3.4 million people who hit the doughnut hole stopped their treatment regimen in the last year.

About 10 percent of them were diabetics. Uncontrolled diabetes can lead to coronary artery disease, kidney failure, blindness, limb amputations and death. Others who stopped were using equally critical blood pressure control medication.

“If you have insulin-requiring diabetes, it can be life-threatening because you can’t go more than a few days without insulin,” said Dr. Dan Einhorn, vice president of the American Association of Clinical Endocrinologists. “For Type 2 diabetics, you can get a bad effect over time.”

Sylvia Finch, a diabetic on the Medicare drug plan, reached the doughnut hole last June. She was on seven medications at the time.

“When I reached it, I was really upset,” she said. “One of the drugs I was on was 300-some dollars for a 90-day supply.”

To save money, she switched one prescription to an over-the-counter medication. Another brand-name drug was replaced by two generics. Finch, 67, of Newark, didn’t experience any side effects from the switch.

“The transition was fine,” she said. “I was concerned about the money, but once I got everything into a generic state, that cut all the costs down.”

If she couldn’t afford the medications, Finch said, she’d look to find outside help. The Kaiser study accentuates the need for programs that help bridge the doughnut-hole gap.

The Republican-led Congress in 2003 crafted the doughnut hole as a way to make the drug benefit more affordable for the federal government.

Programs are available to assist people. AZ&Me, a program offered by AstraZeneca, helps certain people with annual incomes below $30,000. Two state programs also are available.

The Delaware Emergency Medical Diabetes Fund, run by the state, provides diabetes services, medications and supplies to residents of Delaware on an emergency basis. The Delaware Prescription Assistance Program — known as the state “pill bill” — can pay up to $3,000 for prescription drugs a year.

“Most of them who stop taking the medicine do it because of monetary reasons,” said Darrin Anderson, executive director of the Delaware chapter of the American Diabetes Association. “Prescription drugs can be extremely costly. And for some people, if the difference is between buying bread and buying meds, they’ll buy bread.”

The Kaiser Family Foundation study also found that 16 percent of patients with high blood pressure and 18 percent of patients with osteoporosis stopped buying their medicine when they hit the coverage gap. Least likely to cease taking their meds were Alzheimer’s patients, at 8 percent.

About 5 percent of the people who hit the Medicare coverage gap switched to another medication, most often a generic drug, while 1 percent reduced the number of medications they were taking in a particular class of drugs, the report said.