Diabetes Meds May Be Falling Through 'Doughnut Hole'

Medicare payment gap prompts some to forego medication, study finds

THURSDAY, Jan. 7 (HealthDay News) -- Medicare's so-called "doughnut hole" could be forcing many American seniors to skip their diabetes medications, a new study suggests.

The doughnut hole refers to a gap in the Medicare Part D prescription drug coverage plan. Medicare covers the cost of prescription drugs up to a certain amount each year. After that, people must pay for the drugs themselves until they've spent a specified amount. Then, coverage begins again.

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What happens because of this gap -- when Medicare is not paying for the medication -- was the focus of the study, conducted by researchers from Kaiser Permanente and the David Geffen School of Medicine at the University of California, Los Angeles.

The study used data from 2006, when Part D coverage included up to $2,250 in total drug costs paid by both the patient and plan. After spending that amount, beneficiaries entered the doughnut hole, where Medicare paid nothing toward drug costs. The plan started paying again when people reached $3,600 in total out-of-pocket drug expenses for the year.

The researchers looked at the effect of the doughnut hole on drug costs and diabetes medication adherence among participants in two large health systems that offered Medicare D plans. People were classified as adhering to their medication if they filled their prescriptions at least 80 percent of the time.

Compared with those who had supplemental drug benefits, people with the doughnut-hole coverage had higher out-of-pocket drug costs and were more likely to skip their diabetes medications, the study found.

"We found that having a gap was associated with lower total drug spending among diabetes patients, compared with having no gap," study author Vicki Fung said in a news release from the Center for Advancing Health. "However, at least some of those cost savings were due to beneficiaries reducing their use of chronic medications, which may result in worse health outcomes."

The study was published online in Health Services Research.

More information

The U.S. Centers for Medicare and Medicaid Services offers more on reducing drug costs during the coverage gap.

-- Robert Preidt