Seniors Stop Taking their Heart Medication Due to Financial Issues – Medicare Donut Hole to Blame

April 18, 2012 Senior Medicare Issues

When seniors arrive at a certain age, many times, medication becomes a necessity of daily life. Many issues surrounding a person’s day-to-day routine get complicated and more difficult to deal with as they age.  After working a lifetime at a chosen profession, contributing to the tax, Social Security and Medicare systems, the last thing seniors need is an additional burden in the inability to continue their monthly medication regiment.  As much as we’d like to consider ourselves the bastion of advanced civilization in the world, many aspects of our system are broken.

The Medicare Part D donut hole is one of those aspects of our senior and healthcare support system that need addressing. The donut hole is a gap period during each year where seniors who have drug expenses beyond a certain levels must fork-out for their own medication.  The average amount of time in the donut hole for seniors is 3 1/2 months.  This can be very expensive and difficult for seniors given some of the high cost of today’s pharmaceuticals.

Where the situation gets particularly serious is where seniors are on maintenance medications to support the health of their hearts. These medications may be for high blood pressure, cholesterol control or congestive heart issues.  They are critical for the ongoing strength and continued proper operation of their heart muscles and cardiovascular systems.

It is now coming to light that those on tight budgets are additionally stressed when their Medicare Part-D prescription drug coverage goes dormant after they reach the donut hole part of the year.  Unfortunately, these seniors have choosen to simply discontinue these critical drugs rather than use their credit cards or stress their budget to pay for them.

Jennifer Polinski, an instructor of medicine at Harvard Medical School performed a study of 120,000 Medicare participants who suffered from cardiac conditions.  Complete results of the study have been published in the April 17 journal “Circulation: Cardiovascular Quality and Outcomes.”

The study looked at participants during the lost coverage gap periods in the years 2006 and 2007.  For the 2006 year, the donut hole amount was the cost to seniors pocketbooks between where the total amount for their prescription drugs reached $2,250 and where catastrophic coverage kicked in again at $3,600.  In the year 2006, that’s was a $1350 dollar chunk of change for these seniors to absorb.

In the study, Polinski broke-out two groups of 4,000 each for these individuals.  One group had additional assistance, having supplementary insurance that helped cover the gap expenses, while the other group had no gap insurance to assist in the payment of drug costs during the donut hole.

Within the participants who had no additional gap coverage/insurance, Polinski found they were 57 percent more likely to stop taking their drugs during the donut hole period.

The follow-up of the group was only 4 months where the researchers were not able to see any statistical significant difference in the rate of death or other important health issues.  But, the researchers make a specific note that discontinuation of blood pressure, cholesterol or heart medication in the long-term affects to heart health is unclear and may be significantly more pronounced.

In this regard Polinski commented: “I would urge seniors to talk to their pharmacist or doctor. Ask them if there’s something cheaper you could be taking, and if you can’t afford all of your medication, ask them to prioritize which drugs are the most important for you to be on,”

Cardiologist Dr. Tara Narula, working at Lenox Hill Hospital in New York City, agreed with Polinski saying:  “Don’t hesitate to communicate freely with your doctor. Sometimes people are scared or embarrassed to tell their doctor that they don’t have the money. But, your doctor would much rather know that you can’t afford the medication than for you to go without. There are ways we can help you deal with it if we know,” she said.

Narula went on to say: “It’s likely that if the researchers followed this group for a longer time that they would have seen differences in health outcomes. A lot of these patients have a history of hypertension and heart failure. Being off medications, even transiently, can have serious long-term outcomes. And, in some cases, people who just stop for a few days or a week end up with serious problems.”

The new Affordable Care Act has kicked in with reductions in drug costs by 50% during the donut hole gap period.  Unfortunately, this law is currently being challenged in the Supreme Court.  We will have to see what happens with the high court’s decision in June to see if this is upheld.

For Medicare Part-D individuals whose incomes are low can apply for the Medicare Extra Help program (http://ssa.gov/prescriptionhelp/), which subsidizes medications and eliminates the coverage gap.

There are other prescription help programs out there if an individual’s income level is too high for the Medicare Extra Help program.  The Partnership for Prescription Assistance program (http://www.pparx.org/) is a one-stop shop for 475 different patient assistance programs and more than 2,500 medicines.

Those economically stressed by the donut hole dilemma have options.  It’s a matter if searching-out these options and finding something that will keep the medicine that is so critically needed in the medicine cabinet.