Avoiding the (Medicare) “Doughnut Hole”

Depressed Medicare beneficiaries in the so-called coverage doughnut
hole were more likely to cut back on their antidepressants than those who had full
insurance coverage, a study has found.

Even with the Affordable Care Act (ACA) – Obamacare by any other name – well in place and affirmed by the Supreme Court, the costs paid and lifestyles lived by many is being tied to the
“doughnut hole.” This especially is true for seniors taking depression medications.

As recently reported in Med Page Today, a new study by Yuting Zhang, PhD, of the University of Pittsburgh, Medicare may not fully cover depression medications for seniors, despite the ACA. The article is titled “Antidepressants 'Fall' Through Doughnut Hole.”

If you are unfamiliar with the “doughnut hole” issue, you are not alone. It is the coverage gap created by Medicare Part D. For those whose income is at the lower end, there tends to be coverage. Likewise, for those who have an upper-end income, there is still coverage… with a gap in between.

According to the new study, and sheer intuition, patients that fall within the doughnut hole are associated with a significant drop in medication use – 12% on average. That is always
relevant, but perhaps especially so in the case of depression medication. While
discontinuing any prescribed medication is never advisable, it is often easier
to justify foregoing depression medication than other medications.

I certainly recommend reading the original article for more details regarding this study, should this issue be relevant to you or someone you love.

Reference: Med Page Today (July 5, 2012) “Antidepressants 'Fall' Through Doughnut Hole”

Comments

[Dennis Byron]

Mr. Tierney

This is a totally incorrect explanation of the donut hole. You are doing a great disservice to senior citizens by spreading fasle information.

You say:

"For those whose income is at the lower end, there tends to be coverage. Likewise, for those who have an upper-end income, there is still coverage… with a gap in between."

The donut-hole gap has no relationship to a senior's income but to how much he or she spends on prescriptions based on the prescriptions' retail price. Only 5% of seniors spend enough to reach the donut hole gap of around $3000 in drugs (for which they would have paid only $750). Less than 1% spend through it. For 95% of us it is a non issue.

In Massachusetts, it is an issue for even fewer seniors because the donut hole does not matter except to very high income retirees.
-- Low income seniors receive a drug policy for free from the Federal government with very low co-pays; they are not affected by the donut hole at all no matter how high the cost of their prescriptions at retail.
-- Middle income Massachusetts seniors have a state program called Prescription Advantage that protects middle income seniors from spending more than $3260 on drugs (whereas in the donut hole, in a state without additional assistance, a senior could spend an unlimited amount out of pocket if they were very sick or had some chronic condition requiring expensive drug therapy). Again very few seniors spend anywhere near the total where they would need the Prescription Advantage program but it is good to sign up for it just in case.
-- Only Massachusetts seniors with more than $55,000 in income as individuals ($75,000 as a couple) might be affected by the donut hole but that is very high income for a retiree

As for the research, as you can see with so few people actually ever anywhere near the donut hole and so few people relatively speaking taking antidepressants, this is a study about nothing.