The Formulary Files

‘Doughnut hole’ leaves 3.4M without coverage

Approximately 3.4 million Medicare beneficiaries enrolled in Part D reached the gap in their prescription coverage (called the doughnut hole), and some stopped taking their medications as a result. A study from the Kaiser Family Foundation finds that 26 percent of Part D enrollees in 2007 reached the coverage gap.

Beneficiaries taking drugs for chronic conditions had a substantially higher risk of a gap in coverage. For example, 64 percent of enrollees taking medications for Alzheimer’s disease reached the coverage gap and 8 percent stopped taking their medications once they reached the limit.

Of enrollees using multiple drugs, on average 20 percent who reached the gap either stopped taking a medication in that drug class, reduced their medication use (e.g., skipped doses), or switched to a different drug in that class when they reached the gap.

After reaching the coverage gap, percentage who …

Note: Enrollees may use drugs in more than one of the eight drug categories

Source: Georgetown University/National Opinion Research Center/Kaiser Family Foundation analysis


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