Some elderly Americans simply stop taking their prescribed drugs when insurance plans cease paying for them, U.S. researchers reported on Tuesday.
And when the benefits reset at the beginning of a new year, many fail to resume taking their drugs, the team at the nonprofit Rand Corporation found.
The findings suggest the same may happen when patients enrolled in Medicare’s new “part D” prescription plan hit gaps in coverage popularly known as the doughnut hole, they said.
“Prescription use falls significantly as patients reach their benefit caps,” said Geoffrey Joyce, a health economist who led the study at the research organization.
“Most of the drugs we studied help prevent long-term complications of chronic disease so there are likely to be adverse health consequences for seniors who hit their caps.”
Joyce and colleagues studied 60,000 retirees enrolled in a private health plan offered by a large national employer in 2003 to 2005. They had a choice of two drug plans that offered annual drug benefit caps of $1,000 or $2,500 and a third that had no spending limit. Participants had a co-pay in each of the plans.
Between 6 percent to 13 percent of the patients enrolled in drug plans with caps reached their spending limits in each of the years studied, with about half going uncovered for more than 90 days.
They were more likely to forgo prescription drugs than those in plans with no cap, the researchers reported in the journal Health Affairs.
This ranged from 15 percent of people taking cholesterol-lowering drugs to 28 percent of people on heart drugs.
To the surprise of the researchers, few of the patients switched to cheaper generic drugs.
“Given the importance of these drugs, it’s distressing that the resumption rates are not higher,” said Dana Goldman, director of health economics at Rand.
“Drug caps are a cost-saving measure, but our findings raise the issue of whether in the long run they may lead to other medical costs such as increased hospitalizations.”