Sometimes I Feel Like a Piece of Bologna

Tuesday, July 10, 2007

Unintended Consequences of Medicare Part D

In an article, “How The Medicare Doughnut Hole Is Making American Seniors Sick,” Jeremy Cockerill talks about the heath consequences of seniors hitting the donut hole under Medicare Part D. He says,

An estimated 7 million Medicare Prescription Drug Plan beneficiaries will hit the coverage gap in 2007. Hitting the doughnut hole can have very serious health consequences for seniors. In fact, it can even potentially result in death.

He quotes a 2006 study published in the New England Journal of Medicine called, "Unintended Consequences of Caps on Medicare Drug Benefits," that found that drug plans with a cap on drug coverage (such as the doughnut hole in the Medicare Drug Plan) have an annual death rate that is 22% higher than plans that do not limit drug benefits. In addition, the study found that individuals whose benefits were capped were less likely to adhere to their long-term prescription drug therapies once they reached the coverage cap. This led to significant increases in hospitalizations and emergency room visits.

Cockerill suggests that by creating a gap in coverage in Part D, Congress actually created the potential for a major health crisis for seniors once they hit the doughnut hole. As drug prices continue to rise each year, seniors will be at greater risk of hitting the donut hole and being unable to afford their medications while there. From April 2006 to April 2007, Medicare drug plan prices increased 9.2% on the top 15 drugs prescribed to seniors.

Cockerill concludes,
These price increases, combined with the doughnut hole, will lead to a vicious cycle of non-adherence to drug therapies and poor health outcomes. During the time of year when seniors are hitting the doughnut hole (usually in the late summer and fall months) many will simply stop taking their medications. Come January, when a new Medicare benefit year begins, seniors will start up their therapies again. That is, if they were able to survive the doughnut hole.

With the death of my step dad, I’ve been less aware of the donut hole this year. But obviously it continues to be a problem.


2 comment(s):

While I won't disagree with these conclusions, I did say to my sister who was complaining about the doughnut hole: Well, you had NO coverage before you had medicare D. She has a plan with no monthly fee!

The problem in her family is that her husband lost his job with benefits and could only find a job without benefits. She is on disability because she has multiple health problems. She is on many meds, so I say "well, DUH!" to the people who think it just fine to put someone on Social Security disability and then make them wait two years to qualify for Medicare.

Another GROWING problem: the ageing of the baby boomers swelling the ranks of the VA system, not to mention that we are making more veterans every day. Veteran Boomers who had jobs with benefits sometimes have worked for companies which went bankrupt or cut benefits or they retire early. So they turn to the VA system to get their drug coverage.

Last year, our Pres in Washington tried to cut the VA drug coverage in the budget.

This stuff is expensive no matter what. But too bad that the Medicare D system pays the insurance companies so well to handle it. The govt. must pay them well; how could some of the plans be totally FREE otherwise????

By Blogger P.S. an after-thought, at 8:14 AM  

I found a prescription discount card to use while in the donut hole. It's only $4.50 a month and gives savings up to 80%. It's at

By Anonymous Anonymous, at 10:57 AM  

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