Medicare Coverage Gap Leads to Drug Discontinuation

About 57 percent of Medicare Part D patients stop taking cardiovascular drugs in coverage gap

WEDNESDAY, April 18 (HealthDay News) -- Part D Medicare beneficiaries who do not have financial assistance during the coverage gap are at increased risk for cardiovascular drug discontinuation, according to research published online April 17 in Circulation: Cardiovascular Quality and Outcomes.

Jennifer M. Polinski, Sc.D., M.P.H., of the Brigham and Women's Hospital in Boston, and colleagues conducted an observational study involving 3,980 Medicare beneficiaries with cardiovascular conditions who reached the coverage gap spending threshold but did not have supplemental insurance (exposed). These participants were matched with 3,980 Medicare beneficiaries who reached the threshold but had either a Part D low-income subsidy or supplemental insurance (unexposed). Patients were identified from a database of 122,255 heart disease patients who reached the coverage gap in 2006 or 2007.

The researchers found that exposed Medicare beneficiaries were 57 percent more likely to discontinue, but no more or less likely to switch cardiovascular drugs during coverage gaps compared with beneficiaries with either a Part D low-income subsidy or supplemental insurance (hazard ratio, 1.57; risk difference, 13.76 drugs/100 person-years). The rates of death and other outcomes were not significantly different between the groups.

"We found that sudden exposure to 100 percent of drug costs in the gap still led to abrupt discontinuation of essential cardiovascular medications among those with cardiovascular conditions," the authors write. "Beneficiaries were no more likely to switch to generic medications during the gap."

Several authors disclosed financial relationships with pharmaceutical and medical technology companies as well as with pharmacies, including CVS Caremark, which partially funded the study.

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