Results - First Large-Scale Survey - Impact Of Medicare Part D

American Kidney Fund Unveils Results From First Large-Scale Survey On Impact Of Medicare Part D On Kidney Failure Patients

20 Jul 2007
medicalnewstoday.com

People with end stage renal disease (ESRD), also known as kidney failure, are experiencing significant challenges with the Medicare Part D prescription drug program, according to results from a nationwide survey released by the American Kidney Fund , the nation's No. 1 source of financial assistance to kidney patients.

"These survey findings confirm that patients with kidney failure are having serious challenges with Medicare Part D for several reasons. Most notably, these patients often reach the coverage gap, or 'doughnut hole,' phase of the program faster than other beneficiaries because their medication costs are often twice as high," said LaVarne A. Burton, CEO of the American Kidney Fund. "When kidney patients are in the coverage gap, they have difficulty affording the out-of-pocket costs of treatment and often forgo essential medications."

The Medicare Part D coverage gap or "doughnut hole" occurs when a beneficiary has used $2,400 to cover medication costs. No additional assistance will be provided to patients until covered expenses reach $5,451. Once patients reach the catastrophic limit, Medicare Part D pays 95 percent of their drug costs. These amounts will increase in subsequent years, making it even more difficult for patients to obtain needed assistance.

About the American Kidney Fund Survey

The American Kidney Fund conducted a survey of nearly 700 social workers from dialysis centers and transplant centers nationwide to determine how people with kidney failure were faring under the Medicare Part D prescription drug program. Social workers were surveyed because of their understanding of kidney patient issues, and because social workers are responsible for helping patients complete applications for Medicare Part D and other assistance programs. The social workers surveyed work with more than 58,000 kidney patients, or approximately 15 percent of the total number of kidney failure patients covered under Medicare Part D.

Social workers were asked to rate their patients' experiences along a spectrum in order to assess whether patients were having problems, and if so, to what degree of severity and frequency when it came to access to care, out-of-pocket costs, and navigating the Medicare Part D landscape.

The American Kidney Fund then retained independent health policy analysis firm Avalere Health to analyze the data collected and write a report.

American Kidney Fund Survey Results:

-- Nearly 60 percent of kidney failure patients have problems paying for their medications while in the coverage gap;

-- Kidney failure patients are likely to be unaware of the Part D program-or, when they are aware and seek to enroll, they are likely to experience administrative difficulties during the enrollment phase;

-- Overwhelmingly, kidney failure patients face significant problems accessing medications through their plan's formulary;

-- Many patients are having difficulties paying premiums or deductibles.

"Many kidney failure patients need more education to understand the complex topic of Medicare prescription drug assistance and how they can benefit from the Part D program," said Ms. Burton. "There also is a need for assistance with out-of-pocket costs for medications covered under Part D, and the American Kidney Fund is taking steps to provide this assistance."

The American Kidney Fund used the findings from this survey to develop its Medicare Part D Grant Program for Prescription Bone Disease Medications. This program, open to eligible dialysis patients in the United States, offers up to $2,000 per year in Part D in prescription assistance for the costs of bone disease medications, which are frequently taken by dialysis patients.

Most significantly, the American Kidney Fund's Part D Grant Program helps enrollees with their costs while in the coverage gap, and assistance from the program counts toward patients' "true out-of-pocket" (TrOOP) costs. Under Part D, out-of-pocket costs must be categorized as TrOOP costs in order for the patient to move to the catastrophic coverage level under which Medicare covers 95 percent of drug costs.

For dialysis patients who are not currently in the coverage gap, the grants from the American Kidney Fund's program can be applied to the patient share of the cost to obtain bone disease medications. This program covers commonly prescribed bone disease medications, including Fosrenol®, Hectorol®, Phoslo®, Renagel®, Sensipar® and Zemplar®. Complete eligibility requirements and applications are available at http://www.kidneyfund.org.

In the future, the American Kidney Fund plans to extend its Medicare Part D Grant Program to assist with other medications that are frequently needed by patients who have kidney failure.

The American Kidney Fund provides direct financial assistance to kidney patients in need and education for those with and at risk for kidney disease. Last year, AKF provided $81.9 million in grant assistance to 63,500 kidney patients. All AKF grant programs are subject to strict eligibility guidelines. AKF provides assistance to people who have exhausted every other means of aid. AKF also maintains a robust program of kidney disease education and prevention. In the past three years, AKF has provided free kidney health screenings to more than 11,000 people in Atlanta, Chicago and Washington, D.C.-three cities with very high rates of kidney failure. The organization runs public awareness campaigns and offers a brochure series and toll-free HelpLine (866-300-2900) to promote public understanding of kidney disease.

http://www.kidneyfund.org

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