July 11, 2012

"Doughnut Hole" Takes a Bite Out of Medication Adherence

PittsburghThe so-called doughnut hole was dangerous to more than the pocketbooks of Medicare Part D beneficiaries who suffer from depression, according to a recent study.

Beneficiaries must buy their drugs out-of-pocket from the end of the initial coverage limit until catastrophic coverage kicks in, and the study found that during this period, the use of prescribed antidepressants notably decreased.

Authors of the report, published in the Archives of General Psychiatry, noted that the coverage gap, "imposes a serious risk for discontinuing maintenance antidepressant pharmacotherapy among senior beneficiaries." Under current provisions in the Affordable Care Act, the coverage gap will not be closed until 2020.

Researchers from the University of Pittsburgh used a 5% random sample of Medicare beneficiaries 65 years or older with depression (n = 65,223) who were enrolled in stand-alone Part D plans in 2007 to examine how patients responded to the coverage gap.

The study found that patients in the gap reduced usage of antidepressants, heart failure medications, and therapies to treat diabetes.

Compared to a group that had full coverage in the gap (because of low-income subsidies or other programs), the no-coverage group reduced use of their monthly antidepressant prescriptions by 12.1%, their heart failure drugs by 12.9%, and oral antidiabetics by 13.4%. Beneficiaries with generic drug coverage in the gap reduced their monthly antidepressant prescriptions by 6.9%.

"If patients discontinue their appropriate medication therapy abruptly, they could be placing themselves at risk for medication withdrawal effects and for relapse or recurrence," the authors concluded. "If they do not notice any effects, they might decide not to resume taking antidepressants. Thus, a gap in drug coverage could place older adults in harm's way, as a result of disruptions in appropriate maintenance antidepressant pharmacotherapy."

U.S. Pharmacist Social Connect