Patients who hit Part D "doughnut hole" twice as likely to quit meds

Medicare Part D beneficiaries who are responsible for 100% of previously subsidized prescription costs are twice as likely to discontinue their medications, according to a new study published in PLoS Medicine.

The study, conducted by researchers at Harvard University, Brigham and Women’s Hospital, and CVS Caremark, found that patients who enter the Medicare Part D “doughnut hole” - having to pay for prescriptions that were previously subsidized - are twice as likely to discontinue their medications as they are to switch to more affordable or generic medications.

“Proponents of the ‘doughnut hole’ argue that the coverage gap benefits the healthcare system by making participants more sensitive to medication costs. There is an expectation that people will seek less expensive drug options when they enter the donut hole,” said Jennifer Polinski, ScD, MPH, with the division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital and Harvard Medical School and lead author of the study.

“However, our findings show that when beneficiaries have to bear the full financial burden of the cost of their medications, they are twice as likely to stop taking their medications altogether and become nonadherent as they are to switch to more affordable or generic drugs. The resulting decrease in medication adherence could ultimately result in higher medical costs as a result of adverse health events,” Polinski said.

The researchers examined prescription drug use among more than 660,000 Medicare beneficiaries enrolled in more than 200 Medicare Part D and retiree drug plans in 2006 and 2007. Approximately one-third of beneficiaries studied reached the “doughnut hole” seven months into the fiscal year. Under the standard Medicare Part D program benefit, enrollees receive financial assistance to pay for drugs until plan and out-of-pocket spending reaches an initial threshold of $2,830. From there, enrollees are responsible for 100% of medication costs until they have spent more than $4,550, at which point the program’s financial benefits begin again.

The study is a product of a three-year research collaboration between CVS Caremark, Harvard, and Brigham and Women’s Hospital that is focused on understanding why many patients do not take their prescriptions as directed and on developing solutions to assist patients in using their medications effectively.