Tuesday, February 3, 2009

Researchers Say "Fill Doughnut Hole"

Researchers at the University of Pittsburgh have found that seniors who reach Medicare's "doughnut hole" cut back on prescribed medications which can cause serious health consequences and increased costs.
The Medicare Part D prescription drug program took effect 3 years ago. But when Congress approved the program, they set an annual individual drug expenditure limit of $2,250. Once that level was reached, if recipients did not have additional prescription insurance,they would have to pay for their medications out of pocket until the annual drug spending reached $5,100. At that point, Part D coverage resumed.
Dr. Yuting Zhang, assistant professor of health economics at Pitt, says she and her team discovered that one in four Pennsylvanians enrolled in Part D reached the doughnut hole (the $2,250 cap)but only about 5% of that group went on to reach the catastrophic phase of coverage ($5,100). That means that 25% of Pennsylvania Part D beneficiaries were paying for drugs out of pocket between the cap and the resumption of coverage. Dr. Zhang says because they have to pay for their medications, these recipients cut back on their monthly prescriptions by 14%.... "Our findings raise concerns about whether people with chronic illnesses who lack doughnut hole coverage are able to effectively manage their conditions. Without needed prescriptions, we could potentially see an increase in hospital and physician costs.
The researchers are recommending to fill the gap, there should be mandatory coverage of generic drugs in the doughnut hole and off-setting government cots by allowing plans to assess a larger co-pay on prescriptions prior to entering the doughnut hole.

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