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Falling into the doughnut hole: drug spending among beneficiaries with end-stage renal disease under Medicare Part D plans.
J Am Soc Nephrol. 2006 Sep; 17(9):2546-53.JA

Abstract

The Medicare Part D prescription drug benefit may facilitate provision of medications by subsidizing drug costs. However, beneficiaries with higher drug utilization may face higher out-of-pocket (OOP) costs under the benefit's "doughnut hole" provisions that substantially increase beneficiary cost-sharing. The Medicare Current Beneficiary Survey Cost and Use data for 1997 through 2001 were used to estimate the impact of the standard Part D benefit on drug expenditures. The sample consisted of adults who were not dually enrolled in Medicaid (41,617 without ESRD, 256 with ESRD). Outcomes were annual total and OOP drug spending projected to 2006, as well as estimates of individual spending changes under Part D. In 2006, ESRD beneficiaries will have mean annual total and OOP expenditures that are approximately twice that of their Medicare peers. The overall impact of Part D on OOP expenditures is similar among all beneficiaries; however, many individuals with employer-sponsored coverage and those with higher costs (especially those with ESRD) may face cost increases with significant monthly variability as a result of reaching the "doughnut hole," a no-coverage gap in the standard benefit. Therefore, ESRD beneficiaries face substantial total and OOP annual expenditures for medications, causing most to reach the Part D benefit gap. Higher OOP costs may lead to reductions in spending and medication use with subsequent treatment gaps that may lead to increased use of medical services. As the new legislation takes effect, policy makers who are considering modifications in the program may benefit from further research to monitor patterns and gaps in coverage, medication use and spending, and hospitalization and survival trends.

Authors+Show Affiliations

Duke University Medical Center, Box 3646, Division of Nephrology, Durham, NC 27710, USA. patel080@mc.duke.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16855016

Citation

Patel, Uptal D., and Matthew M. Davis. "Falling Into the Doughnut Hole: Drug Spending Among Beneficiaries With End-stage Renal Disease Under Medicare Part D Plans." Journal of the American Society of Nephrology : JASN, vol. 17, no. 9, 2006, pp. 2546-53.
Patel UD, Davis MM. Falling into the doughnut hole: drug spending among beneficiaries with end-stage renal disease under Medicare Part D plans. J Am Soc Nephrol. 2006;17(9):2546-53.
Patel, U. D., & Davis, M. M. (2006). Falling into the doughnut hole: drug spending among beneficiaries with end-stage renal disease under Medicare Part D plans. Journal of the American Society of Nephrology : JASN, 17(9), 2546-53.
Patel UD, Davis MM. Falling Into the Doughnut Hole: Drug Spending Among Beneficiaries With End-stage Renal Disease Under Medicare Part D Plans. J Am Soc Nephrol. 2006;17(9):2546-53. PubMed PMID: 16855016.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Falling into the doughnut hole: drug spending among beneficiaries with end-stage renal disease under Medicare Part D plans. AU - Patel,Uptal D, AU - Davis,Matthew M, Y1 - 2006/07/19/ PY - 2006/7/21/pubmed PY - 2006/12/23/medline PY - 2006/7/21/entrez SP - 2546 EP - 53 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 17 IS - 9 N2 - The Medicare Part D prescription drug benefit may facilitate provision of medications by subsidizing drug costs. However, beneficiaries with higher drug utilization may face higher out-of-pocket (OOP) costs under the benefit's "doughnut hole" provisions that substantially increase beneficiary cost-sharing. The Medicare Current Beneficiary Survey Cost and Use data for 1997 through 2001 were used to estimate the impact of the standard Part D benefit on drug expenditures. The sample consisted of adults who were not dually enrolled in Medicaid (41,617 without ESRD, 256 with ESRD). Outcomes were annual total and OOP drug spending projected to 2006, as well as estimates of individual spending changes under Part D. In 2006, ESRD beneficiaries will have mean annual total and OOP expenditures that are approximately twice that of their Medicare peers. The overall impact of Part D on OOP expenditures is similar among all beneficiaries; however, many individuals with employer-sponsored coverage and those with higher costs (especially those with ESRD) may face cost increases with significant monthly variability as a result of reaching the "doughnut hole," a no-coverage gap in the standard benefit. Therefore, ESRD beneficiaries face substantial total and OOP annual expenditures for medications, causing most to reach the Part D benefit gap. Higher OOP costs may lead to reductions in spending and medication use with subsequent treatment gaps that may lead to increased use of medical services. As the new legislation takes effect, policy makers who are considering modifications in the program may benefit from further research to monitor patterns and gaps in coverage, medication use and spending, and hospitalization and survival trends. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/16855016/Falling_into_the_doughnut_hole:_drug_spending_among_beneficiaries_with_end_stage_renal_disease_under_Medicare_Part_D_plans_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=16855016 DB - PRIME DP - Unbound Medicine ER -