TUESDAY, April 17, 2012 (HealthDay News) -- When Medicare stops paying for seniors' medications after they enter the Part D "donut hole," the seniors often go without the drugs, even if the medications are essential for heart health, new research shows.
"We looked at health outcomes within the coverage gap, which averaged about three and half months during a year. While we didn't find short-term adverse cardiovascular events during that time, it's really unclear what this discontinuation would do in the long-term. And, we don't know if they restart the drugs at the beginning of the year when their coverage resets, or if they remain off them," said study author Jennifer Polinski, an instructor in medicine at Harvard Medical School and an instructor of epidemiology at Harvard School of Public Health in Boston.
Polinski's study included more than 120,000 Medicare beneficiaries with cardiovascular conditions who were receiving drug benefits in 2006 and 2007. During that time, those seniors who reached a total of $2,250 in spending on prescription drugs in 2006 or $2,400 in 2007 lost further drug coverage until they reached the amount required for catastrophic care coverage ($3,600 in 2006 and $3,850 in 2007). This coverage gap is commonly referred to as the Medicare Part D "donut hole."
Most of these seniors had high blood pressure, and about one-third had congestive heart failure.
For their research, Polinski's team compared almost 4,000 of these seniors who lost coverage and had no additional coverage to a matched group of almost 4,000 seniors who lost coverage, but had additional financial assistance (such as additional insurance) to help pay for drug costs.
The group who had no additional financial assistance was 57 percent more likely to stop taking the drugs altogether when they reached the initial Medicare limit, according to the study. Neither group was likely to switch medications.
During about four months of follow-up, the researchers didn't find any statistically significant differences in the rate of death or other health outcomes. However, the authors note that it's unclear how stopping heart, cholesterol or blood pressure medications might affect long-term health outcomes.
"I would urge seniors to talk to their pharmacist or doctor. Ask them if there's something cheaper you could be taking, and if you can't afford all of your medication, ask them to prioritize which drugs are the most important for you to be on," Polinski said.
Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City, agreed that anyone who's having trouble paying for their medications needs to talk to their doctor.
"Don't hesitate to communicate freely with your doctor. Sometimes people are scared or embarrassed to tell their doctor that they don't have the money. But, your doctor would much rather know that you can't afford the medication than for you to go without. There are ways we can help you deal with it if we know," she said.
Narula said it's likely that if the researchers followed this group for a longer time that they would have seen differences in health outcomes. "A lot of these patients have a history of hypertension and heart failure. Being off medications, even transiently, can have serious long-term outcomes. And, in some cases, people who just stop for a few days or a week end up with serious problems," she noted.
Results of the study were published April 17 in the journal Circulation: Cardiovascular Quality and Outcomes.
Since the study began, changes in Medicare drug coverage have already occurred. Under the new Affordable Health Care act, when people reach the donut hole, new discounts kick in. Brand name drugs are currently discounted 50 percent and generic drugs are discounted by 7 percent, and the generic discount will be going up, according to Hilary Sohmer Dalin, director of policy and programs for the National Center for Benefits Outreach and Enrollment at the National Council on Aging, in Washington, D.C.
While the Affordable Health Care act awaits a U.S. Supreme Court ruling on its legality, it's unclear what will happen to the new discounts. Sohmer Dalin said it's likely coverage would revert to the former Medicare Part D plans if the Supreme Court throws out the whole law.
But, no matter what happens in the courts, she said, people who have Part D and low incomes can apply for the Medicare Extra Help program, which subsidizes medications and eliminates the coverage gap. For those whose incomes are too high for the extra help program, Sohmer Dalin said it's "important to know what drugs you're taking and to talk to your health care provider to find the best drug regimen that works and is affordable for you."
To find out where to get help paying for prescription drugs, or to see if you qualify for the Medicare Extra Help program, visit the National Council on Aging. This service is free.