Filling the donut hole: why it matters

A new study of the Medicare prescription drug benefit found that patients who enter the “donut hole” or coverage gap are twice as likely to discontinue their medications as they are to switch to more affordable or generic medications.

The study conducted by researchers from Harvard University, Brigham and Women’s Hospital and CVS Caremark suggests that Medicare Part D enrollees who have to bear the full cost of their medications are less likely to take their medicines as prescribed by their health care professionals.

“The resulting decrease in medication adherence could ultimately result in higher medical costs as a result of adverse health events,” said Jennifer M. Polinski, lead author of the study.

Annual excess health care costs due to medication non-adherence in the U.S. are estimated to be as much as $300 billion annually, according to CVS Caremark.

But there’s good news.

Efforts are underway to help those in Medicare Part D get the medicines they need, even as they go through the coverage gap.

As part of its support for health care reform legislation, the pharmaceutical industry agreed to cut out-of-pocket costs on brand name medicines by 50 percent for Medicare patients who reach the coverage gap.

And there’s growing evidence that seniors access to prescription medicines through Medicare Part D is improving health outcomes and lowering costs.

Earlier this year the Centers for Medicare & Medicaid Services (CMS) posted data that shows beneficiaries in the Medicare prescription drug program are accessing the medicines they need and saving money as they reach the coverage gap in the Part D benefit design.

American seniors’ increased access to medicines via the Medicare prescription drug program led to reduced spending on post-acute care such as hospitals and nursing homes.

AstraZeneca also provides support to Medicare patients who need help paying for our medicines through our prescription savings programs. Click here to learn more about this program and whether AstraZeneca may be able to help you or your family save on your prescription drug costs.