Managed Care - October 2008 - (Page 34) 20 percent of Medicare enrollees reached the gap by July 2007, and by December, nearly half were in the gap or in the catastrophic coverage phase. Wolters Kluwer Health found that beneficiaries spent an average of 35 more days in the coverage gap last year than they did in 2006. For health plans, the coverage gap presents inherent risks because of medication noncompliance when members fall into the noncovered period. The Wolters Kluwer Health report shows that when faced with increased costs for their medications, many enrollees took prescription decisions into their own hands, with 16 percent discontinuing therapy. And the longer beneficiaries remain in the coverage gap, the more prone they are to become nonadherent with their medication regimen. A Medco analysis of patient compliance by beneficiaries using cholesterol-lowering statin medications in different stages of the Medicare benefit found that beneficiaries in the coverage gap were nearly twice as likely to stop taking their medications as those in the initial phase of coverage. For patients and health plans, the impact of noncompliance can be costly. For example, not remaining compliant with cholesterol-lowering medications can lead to increased risk of heart attack or stroke, resulting in significant hospitalization costs. Compliance is also essential for reducing costs for diabetes patients. A study in the journal Medical Care found that for every $1 spent on Medicare Part D becoming less of an advantage edicare Part D patients pay less for medications then patients in commercial plans, but the gap between the two groups appears to be shrinking, according to a study by the health information processing company Wolters Kluwer Health. “In 2006, Medicare patients paid, on average, $17.58 for a 30-day supply of branded drugs in the top 10 therapeutic categories,” the study reports. “Comparing this to the average patient pay of $37.54 for commercial patients, there is a significant cost savings for the Medicare patient in 2006.” That advantage seems to have lessened in 2007, however, with the gap in what patients have to pay in Medicare Part D and those in commercial plans closing considerably. M Significant differences in cost Average cost to patients for Part D’s leading therapy classes in Medicare and commercial plans $70 Average Part D 30-day supply 2006 2007 Average commercial 30-day supply 2006 2007 $35.67 $59.94 $60 $49.49 $30.79 $28.86 $24.21 $26.63 $26.20 $32.06 $40 $36.01 $37.18 $38.98 $17.82 $23.07 $22.34 $16.16 $20.41 $17.41 $21.86 $17.73 $22.23 $30 $17.88 $23.83 $17.35 $20 $0 Antihypertensives Lipid regulators Antidepressants Gastrointestinal therapy Respiratory therapy Diabetes therapy Diuretics Antiinfectives Hormone therapy Analgesics Source: “Medicare Part D — Market Dynamics,” Wolters Kluwer Health, June 2008 34 MANAGED CARE / OCTOBER 2008 $2.37 $2.16 $3.41 $10 $11.47 $14.74 $14.05 $16.78 $21.90 $25.35 $24.16 $24.01 $23.99 $43.11 $50 $43.53 $45.07 $53.97
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