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Medicare “Doughnut Hole” Leads Some Elderly to Go Without Medication

By August 22, 2008

This Week’s Medication News
Each week, Dr. Mike highlights the latest news about medications.

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 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.

The complete study is available from the Kaiser Family Foundation:

More Information from Dr. Mike

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Comments
September 2, 2008 at 10:30 am
(1) Suzy says:

I am on SSDI, so I am also on Medicare part D,
and it really sucks! I used to have two ins
policies, Medicare and Medicaid but b/c my
son’s income went up $20 too much for their
standards (Medicaid, that is), they took me right off Medicaid and left me to sink in the ship of Medicare, which I’m doing. In the very beginning of the year there is a deductible that has to be met, b4 I have a much smaller co-pay. I forget what the exact amount of the deductible is but it’s a good amount, and it really burnt a hole in my pocket, so to speak. Anyway, then a period of co-payments are here and it’s good for a while. Then the doughnut hole comes into play, and everyone on Medicare has to pay out of pocket again, just like at the beginning of the year – when we were trying to meet our deductible. How do folks on Medicare do it?? Not only are we left with 20% of a medical bill, which does eventually add up quickly, we have to pay out of pocket 4 these ridiculous meds!! No wonder why people stop their meds!

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