Medicare Part D Benefits Draws Mixed Signals

The Medicare Part D benefit has resulted in some improvements for seniors but no real revolution in prescription drug adherence.

By: Steven Chu
Apr 22, 2008, 6:39 PM EDT

A new report finds that Medicare beneficiaries are less likely to forego basic needs such as food to pay for medicine, but the sickest patients are still skipping meds on account of high costs.

"It's a mixed picture. We saw some things to be happy about and others to be concerned about," said study author Jeanne Madden, an instructor in the department of ambulatory care and prevention at Harvard Medical School in Boston.

Medicare Part D, which provides drug benefits, took effect in January 2006. More than half of Medicare beneficiaries have enrolled in the program. Some 10 percent of beneficiaries still have no drug coverage, in comparison to up to 38 percent before the program took effect.

Surveys have shown that without adequate prescription drug benefits, seniors tend to skip doses, reduce doses or leave prescriptions unfilled. This, in turn, can result in serious health outcomes, including even heart attack and stroke.

Madden and her team looked at survey responses from 24,234 Medicare beneficiaries to figure out how Medicare Part D had changed cost-related adherence to drug regimens.

In 2004 and 2005, before Part D, 15.2 percent and 14.1 percent of beneficiaries, respectively, skipped pills due to cost, versus 11.5 percent in 2006, after the program was set up.

Similarly, in 2004 and 2005, 10.6 percent and 11.1 percent of beneficiaries, respectively, skimped on basic needs so as to be able to pay for medications, a percentage which declined to 7.6 percent in 2006.

The sickest individuals continued to skip pills at about the same rate both before and after Part D, although they were less likely to forego basic necessities. These beneficiaries are more likely to falling into the "donut hole," when drug costs are between $2,250 and $5,100, private individuals have to pay the full cost of their drugs.

A second study found that not only did Medicare beneficiaries enrolled in Part D still skip doses or switch to cheaper drugs, many do not understand the program.