Rat Poison & Medicare's Part D Doughnut Hole

The Kasier Family Foundation paper, "The Medicare Part D Coverage Gap Costs and Consequences in 2007", by J. Hoadly, E. Hargrave, et al., August 2007, analyzes Medicare beneficiaries' doughnut hole experiences in 2007, the first full year of Part D operation. Twenty-six percent of Part D enrollees reached the coverage gap (half by late August), which left them to bear the full cost of further 2007 prescriptions within the doughnut hole, and fifteen percent of these individuals went on to reach catastrophic coverage. Tha authors found that 15 percent stopped taking their medication, 5 percent switched to an "alternative drug in that class" and 1 percent reduced their medication use. 10 percent of the diabetics who reached the doughnut hole coverage gap stopped taking their medication, 8 percent switched to an alternative and 5 percent cut down on their medication use. The authors also noted that monthly outlays by the doughnut hole patients jumped from $104 to $196 during the gap.

One method, often and emphatically recommended by insurers to save money, is to purchase generics which are theoretically "bioequivalent" to branded products. Coumadin, the branded anticoagulant, is far more expensive than warfarin, the generic. As I mentioned in an earlier blog, an instance in which a patient returned a bottle of warfarin (a form of warfarin is used as rat poison) to a local pharmacy as "ineffective" (meaning, there was no discernable anticoagulant effect by blood test), sent a complaint to the Food and Drug Administration, and had no response either from the pharmacy chain or the FDA to the complaint, raises the question of whether the advice to purchase generics is always prudent. Compounding this specific warfarin problem was the recognition by some physicians in the area where this took place that warfarin supplied by the same pharmacy chain had provided inadequate anticoagulation to their patients.

So patients are in a bind. Spend their limited retirement funds on branded products which will place them in the doughnut hole sooner and aggravate their financial problems, or take "alternatives" which may yield suboptimal benefit and ultimately lead to uncomfortable, dangerous and expensive morbidity and possibly mortality. Or, they can just stop taking the medicines they can't afford to buy, perhaps using prayer rather than science to get through without bankrupting debilitation or death.

Of course, Congress could order Medicare to negotiate pharmaceutical prices for Part D patients, insuring product quality and affordability and ameliorating this unfortunate situation.