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Patients likely to discontinue CV drugs during Medicare coverage gaps
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Medicare Part D beneficiaries with CV conditions who had no financial assistance were found to be 57% more likely to discontinue their medication during a coverage gap compared with patients who had a Part D low-income subsidy or additional insurance, according to recent study results.
Neither group was more likely to switch to other drugs during coverage gaps.
“The coverage gap remains the subject of Congressional debate; evidence regarding its impact on CV drug use and health outcomes is needed,” researchers wrote in the study.The study included 122,255 Medicare beneficiaries aged 65 years and older with CV conditions. All participants had linked prescription and medical claims and had reached the Medicare Part D coverage gap spending threshold in 2006 or 2007. Researchers followed all beneficiaries upon reaching the threshold until an event, the catastrophic coverage spending threshold or year’s end. Researchers then compared CV drug termination rates between 3,980 Medicare beneficiaries without supplemental insurance to an equal number with additional coverage during the coverage gap.
Three percent of beneficiaries received no financial assistance during the coverage gap. Those without supplemental insurance were more likely to discontinue their CV drugs (HR=1.57; 95% CI, 1.39-1.79), including beta-blockers (HR=1.68; 95% CI, 1.28-2.20) and statins (HR=2.16; 95% CI, 1.72-2.71), compared with beneficiaries who had additional coverage.
“However, the impact of this difference on health outcomes is not clear,” the researchers wrote.
No significant differences in rates of death (propensity score-matched HR=1.23; 95% CI, 0.89-1.71) or other outcomes were found. Researchers said this finding contrasts with previous data that examined the impact of lapses in drug coverage in other, non-Part D settings. The difference could be due to the current study’s relatively short follow-up of 119 days, the typical amount of time patients spent in the coverage gap, Jennifer M. Polinski, ScD, MPH, instructor in medicine at Harvard Medical School, said in a press release.
“Given the results we observed, policymakers should be sensitive to the deleterious effects of the coverage gap on CV drug discontinuation and work to protect beneficiaries with CV conditions who may be vulnerable to it,” the researchers concluded.
Disclosure: Dr. Polinski is a consultant to Buccaneer Computer Systems and Service, Inc. See the full study for the other researchers’ disclosures.
Perspective
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L. Samuel Wann, MD
Polinski and colleagues studied the propensity of Medicare Part D recipients to stop refilling prescriptions for potentially important CV drugs when they entered the ‘coverage gap,’ a time when their initial maximum drug coverage had been exceeded, but before they were eligible for ‘catastrophic’ coverage. It will not surprise clinicians that many patients stopped filling their prescriptions when they were required to pay for them from personal funds, without insurance or other financial assistance. Perhaps more surprising was the inability to parse the data to show a difference in health outcome during the ‘gap.’ Also disappointing was the lack of evidence of any move to substitute generic for expensive brand-name drugs. Many useful CV drugs in generic formulations, including diuretics, ACE inhibitors, calcium blockers and statins are available for $4 per month in many pharmacies.
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