"Doughnut hole" discourages drug use

Some 18,000 Medicare beneficiaries could discontinue their prescribed medications for lack of funds, a new study finds. The Brigham and Women’s Hospital study, led by Jennifer Polinsky, found that most Medicare and Medicaid patients chose not to switch to generic or other cheaper alternative drugs, despite being advised to do so by those programs.

Researchers looked at the effect of government drug policy on medication use for 663,850 Medicare beneficiaries beginning in 2006. Medicare Part D was introduced in 2006, but because of the coverage “doughnut hole,” patients must pay 100 percent once they have accumulated $2,830 in drug costs. Three to four million beneficiaries fell into the hole from 2006 to 2010, when the health reform law reduced that burden.

While the study did not examine the effect of the doughnut hole on patient outcomes, there is reason to believe that beneficiaries’ discontinuation of their prescribed medications has had a negative effect on health. “Blunt cost-containment features such as the coverage gap have an adverse impact on drug utilization that may conceivably affect health outcomes,” said Polinsky in the Public Library of Science journal that featured the study.