Diabetes patients without coverage of the Medicare Part D “doughnut hole” spent more out-of-pocket on their medications, compared with diabetes patients who had coverage.
Moreover, modified doughnut hole coverage of generic drugs conferred only “modest differences in out-of-pocket spending” compared with diabetes patients without any coverage at all, according to a recent study.
The study, led by Vicki Fung, Ph.D., of the Kaiser Permanente Medical Care Program in Oakland, Calif., compared diabetes patients in a staff-model, integrated HMO Medicare Advantage Prescription Drug (MAPD) plan. In the first group were 16,654 patients whose Part D plan provided no coverage in the doughnut hole; in the second were 12,126 with employer-supplemented insurance offering some coverage in the gap (Health Serv. Res. 2010 Jan. 7 [doi:10.1111/j.1475–6773.2009.01071.x
A total of 17% of patients without gap coverage had out-of-pocket drug expenses of at least $2,250—putting them in the doughnut hole—as did 35% of those with some gap coverage. Patients without gap coverage had lower annual total drug costs, on average: $1,750, versus $1,802 for patients with employer-supplemented gap coverage, the researchers found. However, patients without gap coverage spent significantly more out-of-pocket ($806) than their covered counterparts ($279).
MAPD plan administrators were able to review the paper but had no control over design, conduct, or interpretation of the study.