Unfavorable Outcomes for Dialysis Patients Reaching the Part D Coverage Gap

[Zach]

http://www.ajmc.com/newsroom/unfavorable-outcomes-for-dialysis-patients-reaching-the-part-d-coverage-gap

Unfavorable Outcomes for Dialysis Patients Reaching the Part D Coverage Gap

The American Journal of Managed Care
Published Online: September 27, 2015

Laura Joszt

Medicare beneficiaries undergoing dialysis who reach the Part D coverage gap have unfavorable clinical and economic outcomes, according to a study published in the Journal of Managed Care & Specialty Pharmacy.
 
Researchers analyzed data from the United States Renal Data System for Medicare-eligible patients receiving dialysis in order to determine the relationship between the Part D prescription drug cost-sharing structure and health and economic outcomes. They found that reaching the Part D coverage gap increased out-of-pocket spending, increased medical service utilization and costs, and increased mortality.
 
“In Medicare populations, the coverage gap has been associated with reduced medication adherence, likely because beneficiaries adopt cost-lowering strategies when entering the coverage gap,” the authors wrote.
 
In particular, beneficiaries with end-stage renal disease (ESRD) are at risk of facing high out-of-pocket costs and 60% of Part D enrollees on dialysis who did not receive a low-income subsidy reached the coverage gap in 2007, according to a previous study.
 
The investigators categorized patients into 4 different cohorts:
Cohort 1: non–low-income subsidy patients who did not reach the coverage gap and paid less than $799 in out-of-pocket costs
Cohort 2: non–low-income subsidy patients who reached the coverage gap and paid more than $799 but less than $3850 in out-of-pocket costs
Cohort 3: non–low-income subsidy patients who reached the coverage gap and paid $3850 or more in out-of-pocket costs
Cohort 4: low-income subsidy patients who did not reach the coverage gap
 
Patients in the 3 cohorts without a low-income subsidy (main cohorts) were older and more likely to be white. Patients in these main cohorts compared to the low-income subsidy cohort had higher rates of hospitalization, outpatient visits, and longer days in hospital.
 
Although there were no significant differences in total medical costs for patients in the 4 cohorts, patients in Cohorts 1, 2, and 3 had significantly higher hospitalization costs compared with Cohort 4. Additionally, Cohorts 1, 2, and 3 had a 15%, 19%, and 33% increased risk of all-cause death, respectively, compared with patients in Cohort 4.
 
“These findings raise concern that the lack of drug coverage could lead to adverse health consequence for financially vulnerable persons,” the authors concluded. “Providing adequate coverage for critical medications could reduce unintended consequences in Medicare beneficiaries on dialysis.”

[Michael Murphy]

What really annoys me if the republican creators of this mess had allowed Medicare to negotiate lower prices the costs of the program would have been lowered so that the donut hole would not need to exist. The way this idiot plan is configured allows big pharma to extort huge amounts of money from the Medicare system.  I order from overseas to avoid this mess.

[smartcookie]

I battle this all the time. It is hard to find cost saving patient assistance programs for my patients since Medicare is a government insurance. Patient Assistive Network Foundation works great for these parents who cannot afford sensipar. Renassist is good for renvela. If anyone is having trouble affording medicines, let me know and I will be happy to help!