Study Examines Impact of ‘Doughnut Hole’ on People Enrolled in 2007 Medicare Drug Plans

Thursday, August 21st, 2008
This post was written by Melanie Matthews

A new analysis from the Kaiser Family Foundation quantifies, for the first time, the number of Medicare Part D plan enrollees in 2007 who reached a gap in their prescription drug coverage known as the “doughnut hole,” as well as the changes in beneficiaries’ use of medications and out-of-pocket spending after they reached that gap. The analysis excludes beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan.

  • One in four (26 percent) Part D enrollees who filled any prescriptions in 2007 reached the coverage gap. This includes 22 percent who remained in the gap for the remainder of the year, and 4 percent who ultimately received catastrophic coverage. Applying this estimate to the entire population of Part D enrollees, the analysis suggests that about 3.4 million beneficiaries (14 percent of all Part D enrollees) reached the coverage gap and faced the full cost of their prescriptions in 2007.
  • Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan. For example, 64 percent of enrollees taking medications for Alzheimer’s disease reached the coverage gap in 2007, as did 51 percent of those taking oral anti-diabetic medications and 45 percent of patients on antidepressants. As noted above, these percentages are among Part D plan enrollees who did not receive low-income subsidies.
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