The doughnut hole dilemma

Patients who get drug benefits under Medicare Part D can look forward to $2,250 in drug benefits (increased to $2,500 in 2007), and after that they enter a land of no coverage that stretches on until they've paid for the next $3,600 worth of medicines out of their own pockets.

In a study sponsored by Novo Nordisk and presented as a poster this morning at the ADA's Scientific Sessions, researchers analyzed how that coverage gap, known as "the doughnut hole,'' affected people with diabetes who take insulin. Using prescription data representing half of all retail drug dispensing activity in the U.S. in 2006, they found that of the more than 40,000 -- 12% of all Medicare beneficiaries -- who entered the doughnut hole, almost half (49%) were able to remain on the same diabetes medications they had been taking, but 24% dropped at least one treatment, 16% discontinued all treatments and 13% began a new treatment.

But that might not be as worrying as it seems, says Christopher Conner, senior manager for health economics at Novo Nordisk, one of the study authors. The research provides a snapshot in time, rather than a full picture, he says. Patients who "discontinued all treatments'' may well have started newer treatments or switched to generics, he says, and would have been counted in more than one category. While it's likely some patients stop taking needed drugs because of cost, there may be others who had no prescription drug coverage at all until Medicare Part B was enacted in 2006, he says. "How many patients dropped all medications and didn't start new ones, we don't know,'' he says. "This study is a jumping off point for further investigation.'' He says a larger study has been done by the Centers for Medicare and Medicaid Services and will be published later this year.

Comments

[Dottie Weymuller]

It is a real struggle to pay for medications for diabetes and other problems I've developed due to the diabetes. I know I'm not alone in that dilemma but with the numbers of diabetics increasing at the current rate, something real and tangible has got to be done for the underinsured in this country. So many are desperately struggling to continue to afford medications. How many people cannot begin to afford that next $3600 out of their pockets under the Medicare Part D? I used to be shocked that this country can just ignore it's sick and uninsured but after the last 8 years, nothing shocks me. It's pretty discouraging and disgraceful that people must become so desperate for life saving treatments and drugs.