Medicare coverage expanded a bit in 2006 to include coverage for prescription drugs, Part D, provided a Medicare beneficiary chose to enroll in Medicare Part D.  Now that the prescription coverage plan has been in effect for a while, a review survey covering the year 2006 reveals mixed opinions for the plan.

In essence, the Medicare Part D provides coverage for prescriptions up to a total expenditure of $2,250 ($2,510 for 2008).  At that point, the beneficiary is required to pay 100% of all prescription expenses until total expenditure reaches $5,100 ($5,726 for 2008).  After the $5,100 (or $5,726) mark has been reached, Medicare’s participation comes back into play, paying 95% of additional drug expenses for the remainder of the year.

It’s this so-called doughnut hole in coverage that has left many of the sickest and chronically ill Americans skipping pills, not filling prescriptions or refills, and cutting back on other necessities of life, such as food, in order to get needed medications.

About half of all Medicare beneficiaries enrolled in Plan D, which was designed to increase access to prescription medications for the chronically ill and the poor.  Estimates vary but studies estimate about 10% to 30% of eligible Americans are still not getting coverage for prescription medications.

The survey was conducted by the Centers for Medicare and Medicaid Services and funded by the Harvard Pilgrim Health Care Foundation and the National Institute on Aging.  Researchers examined the responses of 24,234 Medicare patients who had also responded to the Medicare Current Beneficiary Survey during 2004, 2005, and 2006.

Medicare beneficiaries with two or more chronic illnesses made up more than 72% of the survey’s respondents.  The number of patients skipping prescribed drugs dropped from 14.1% in 2005, before Plan D, and only 11.5% reported doing so after Plan D’s inception in 2006.

The number of people skipping other basic needs such as food dropped from 11.1% in 2005 to 7.6% in 2006.

The sickest Americans skipped prescribed medications at nearly twice the rate of their healthier counterparts during 2004 and 2005.  This almost-50% rate remained stable even after Plan D became available although these same patients do report less cutting back on basic needs other than prescriptions.

Skipping doses or not filling prescriptions can lead to expensive hospital stays that could likely have been avoided with adequate medication.  The principal investigator for the study, Stephen Soumeral, a professor at Harvard Medical School, calls plugging the doughnut hole a good start to minimizing the number of people who feel they must skip medication in order to make ends meet.

Soumeral urges the next administration to actively enroll the three or four million Americans who are eligible for coverage but do not currently have it and to re-evaluate the high patient cost of the doughnut hole in Medicare Plan D, especially when chronically ill people require a large number of medications for proper treatment.

Harvard Medical School’s Dr. Jeanne Madden, lead author of the study, says signs of relief are encouraging but unmanageable prescription expenses are still a problem for many Americans.  She considers Medicare Part D a work in progress with need of more work.

The details of the study can be found in the April 23 issue of JAMA, the Journal of the American Medical Association.