Ohio Department of Aging
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October 2007
Spending Caps Cause Some Seniors to Forgo Meds
Many seniors quit taking drugs for chronic illnesses such as diabetes and high blood pressure when they exceed their drug plan's yearly spending limits, according to a RAND Corporation study. Even when drug benefits resume at the start of a new health plan year, a significant number of seniors do not resume their prescription medications.
In the years studied, the percentage of people who reached their spending limits in programs with caps ranged from 6 to 13 percent. About half of those affected went without benefits for more than 90 days. Among patients who stopped taking a medication in the capped plan, more than half did not restart their prescriptions during the first three months after benefits resumed.
High spenders in the capped plans were more likely to discontinue use of their medications than people enrolled in the plan with no spending limits, according to researchers. Discontinuation rates differed by type of drug, ranging from 15 percent for anti-cholesterol medication to 28 percent for cardiac drugs. Rates were higher for pain medications and anti-ulcer drugs where over-the-counter alternatives were available.
Surprisingly, people did not switch to generic drugs, given they are generally cheaper than name-brand medications. While people were less likely to quit using generic drugs once they reached benefit caps, no widespread move to the lower-cost alternatives was noted.
Researchers said the study may help guide policymakers who are concerned with the so-called "doughnut hole" in Medicare prescription drug plans. Spending limits contained in the Medicare drug plan are expected to leave between 24 percent and 38 percent of enrollees without drug coverage for part of each benefit year.
Ohio Department of Aging