60-Second Science

Medicare Doughnut Hole Swallows Meds

Medicare recipients in the so-called doughnut hole, where they foot the complete bill for their drugs, are twice as likely to skip meds entirely than are those who get other assistance. Katherine Harmon reports

Some 50 million Americans 65 and older currently get help from Medicare. But the program doesn't cover all of a patient's medications. After a patient’s annual drug cost hits $2,800, the patient pays the rest of the tab up to another $4,500. Between three and four million people hit this so-called "doughnut hole" each year, usually in mid-August, and don't qualify for low-income assistance.

Advocates for this coverage gap say it encourages people to choose cheaper drugs, but Medicare recipients who hit the doughnut hole and weren't receiving extra help were twice as likely to forgo at least one prescribed drug as those who got additional subsidies. And they were actually less likely to switch to cheaper options, such as generics. So finds a new study in the journal Public Library of Science Medicine. [Jennifer Polinski et al., "Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap"]

The 2010 health reform law reduces the amount Medicare beneficiaries shell out. But with budget debates about scaling back on entitlement programs, drug coverage might take another hit. And those cuts could mean the difference between following doctor's orders and skipping necessary meds.

—Katherine Harmon

[The above text is a transcript of this podcast.]

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