Women, Diabetics Fall Fast Into Medicare 'Doughnut Hole'
MONDAY, March 29 -- Among elderly Americans, women and those with diabetes and dementia are most likely to find themselves in the Medicare Part D drug plan "doughnut hole," the coverage gap that occurs after a beneficiary has reached the annual coverage limit but hasn't spent enough on drugs to qualify for catastrophic coverage.
Researchers analyzed the records of more than 287,000 Medicare enrollees in eight states and found that 16 percent of them entered the doughnut hole. Nearly 3 percent entered the gap very early -- within the first 180 days of the year. Of the enrollees who entered the gap, only 7 percent eventually qualified for catastrophic coverage.
Along with women and patients with dementia and diabetes, patients most likely to fall into the doughnut hole included those with end-stage renal disease, coronary artery disease, chronic obstructive pulmonary disease, mental health conditions and congestive heart failure.
These groups should be counseled by doctors on how best to manage medication costs through either drug substitution or discontinuation of certain nonessential medications, study lead author Susan Ettner, professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine, University of California, Los Angeles, said in a news release.
"This is important so that more essential medication is not discontinued, with adverse effects on patients' health due to cost reasons only. These patients need to continue adhering to their medication regimen," Ettner said in a news release.
The study was published online March 9 in the Journal of General Internal Medicine.
Posted: March 2010