Medicare prescription drug benefit improved access to medications for most seniors, but sickest seniors continued skipping pills because of cost issues, study finds

The percentage of seniors who said they skipped taking medications because of costs declined after the Medicare prescription drug benefit took effect in January 2006, but the sickest beneficiaries still skip prescriptions because they cannot afford to pay for them, according to a study published Wednesday in the Journal of the American Medical Association, Reuters reports.

For the first study, Jeanne Madden and colleagues from Harvard Medical School analyzed data from a government survey of 24,234 Medicare beneficiaries in 2004, 2005 and 2006 and found that 11.5% reported skipping medications in 2006, after the drug benefit was introduced, compared with 14.1% in 2005. The study also found that in 2006, 7.6% of beneficiaries cut back on spending for basic needs, such as food or housing, to afford medications, compared with 11.1% in 2005.

However, beneficiaries classified as the sickest reported no improvement in skipping prescriptions because of cost. These beneficiaries, who account for 27% of overall Medicare Part D enrollment, skipped pills at about twice the rate of healthier people in 2004 and 2005, according to the study.

An abstract of the study is available online.

Cost Issues

A separate study also published in JAMA on Wednesday found that 36% of Medicare drug plan beneficiaries reported changing their behaviors in some manner after enrolling in the drug benefit because of costs, including switching to a less-costly drug, not refilling a prescription or experiencing financial burden. For the study, lead author John Hsu of Kaiser Permanente's Center for Health Policy Studies and colleagues in 2007 surveyed 1,040 Medicare beneficiaries who were enrolled in the drug benefit.

Researchers also found that 60% were unaware their plans had the so-called "doughnut hole" coverage gap. "The new Medicare Part D program provides billions of dollars in new benefits for seniors, but also imposes complex and high levels of cost-sharing," Hsu said in a statement, adding, "The study shows that many seniors have trouble understanding these benefits and that this poor knowledge limits their ability to manage their medication needs and costs" (Dunham, Reuters, 4/22). Please note: The Kaiser Family Foundation is not associated with Kaiser Foundation Health Plan, Kaiser Permanente or Kaiser Industries.

An abstract of the study is available online.

Commentary

"Medicare Part D: A Successful Start With Room for Improvement," JAMA: The JAMA editorial by Dana Goldman and Geoffrey Joyce, both of the RAND Corporation and the National Bureau of Economic Research, discusses successful aspects of Medicare Part D, as well as emerging concerns, including increasing copayments and changes in medications. The authors also examine whether the doughnut hole gap is generating nonadherence to drug regimens (Goldman/Joyce, JAMA, 4/23).