Managed Care - October 2008 - (Page 33) Help Members to Avoid A Part D Doughnut Hole Crisis Educating members about Medicare Part D saves patients a lot of anguish and payers a lot of money By Woody Eisenberg, MD ondoners are very familiar with the expression “mind the gap,” a warning to subway passengers of the sometimes large gap between the train door and the station platform. On this side of the Atlantic, it could aptly apply to many Medicare beneficiaries who could be risking their health by not taking the precautionary steps necessary to avoid or delay reaching the Medicare prescription plan coverage gap. According to the Kaiser Family Foundation, 3 million Medicare beneficiaries reached the coverage gap in 2007, double the number who reached the gap in 2006. Being unprepared for the coverage gap can lead enrollees down a dangerous path of noncompliance, with patients cutting back on their medications or forgoing them altogether — behaviors that put them at greater risk for higher health care costs and poor clinical outcomes like increased hospitalizations. Health plans also feel the effects, with their medical costs increasing as a result of their members’ actions. Effectively communicating with members about the coverage gap can help avoid such scenarios. By doing so, health plans not only change behaviors but also improve plan satisfaction and retention. L Doughnut hole keeps getting bigger atients in Medicare Part D may find the coverage gap, or doughnut hole, more and more difficult to fill with their own money. The health data collection company Wolters Kluwer Health reports that “Between 2006, when Medicare Part D started, and 2008, the out-of-pocket spend by the patient to the coverage gap has risen from $2,250 in 2006 to $2,400 in 2007 to $2,510 in 2008.” The deductible also rose during that time. Wolters Kluwer Health analyzed prescription data of 8.8 million patients in 2006, and 9.1 million in 2007 in reaching is findings. P Bottom line keeps moving $7,000 Catastrophic coverage $6,000 $5,000 Doughnut hole $4,000 Total covered Part D drug expenditure at out-of-pocket threshold $3,000 Gap in care Evidence shows that Medicare beneficiaries are reaching the coverage gap earlier in the year and spending more time in it than they were during the first years of Part D. According to Medco research, Woody Eisenberg, MD, is vice president for retiree solutions and chief medical officer for Medicare at Medco Health Solutions. $2,000 Standard coverage $1,000 Initial coverage limit 2006 2007 2008 0 Source: “Medicare Part D — Market Dynamics,” Wolters Kluwer Health, June 2008 OCTOBER 2008 / MANAGED CARE 33
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