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Medicare Spending Caps Cause Seniors to Stop Meds

TUESDAY Sept. 11, 2007 -- Some American seniors stop taking medications for chronic health problems such as high blood pressure and diabetes when they exceed spending limits in their Medicare prescription drug plans, new research shows.

The study, by the nonprofit research organization the RAND Corporation, also found that many of those seniors do not resume taking their prescription drugs when their drug benefits kick in again at the start of a new health plan year.

The RAND team analyzed prescription drug use from 2003 to 2005 among 60,000 seniors enrolled in a health plan offered by a large national employer. The seniors were enrolled in one of three drug plans: one with a spending limit of $1,000; one with a spending limit of $2,500; and one with no spending limit. In each of the plans, enrollees had to pay a portion of their drug purchases.

The study looked at the use of drugs to treat high blood pressure, cardiac problems, diabetes, ulcers, depression, and prescription pain medications that have over-the-counter substitutes.

Reporting in the Sept./Oct. issue of the journal Health Affairs, the researchers found that 6 percent to 13 percent of seniors enrolled in drug plans with spending caps reached their spending limit in each of the years of the study. Of those who reached their spending limits, about half went without drug benefits for more than 90 days.

Seniors in capped plans who spent the most on drugs were more likely to discontinue their use of medications than those in plans with no cap.

Discontinuation of drugs varied from 15 percent for anti-cholesterol medications to 28 percent for cardiac drugs, the study found.

"Prescription use falls significantly as patients reach their benefit caps," lead author Geoffrey Joyce, a senior economist at RAND, said in a prepared statement. "Most of the drugs we studied help prevent long-term complications of chronic disease, so there are likely to be adverse health consequences for seniors who hit their caps."

"Drug caps are a cost-saving measure, but our findings raise the issue of whether in the long run they may lead to other medical cost such as increased hospitalizations," senior author Dana Goldman, director of health economics at RAND, said in a prepared statement.

Posted: September 2007


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