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Medicare News

More Evidence Senior Citizens in Donut Hole Cut Back on Prescribed Drugs

Medicare depression patients take considerable risk in skipping drugs; many cut back on other critical medicine, too; Obamacare could help

July 2, 2012 - Senior citizens with depression who fell into the “donut hole” – the gap in the Medicare Part D prescription drug program where coverage stops – were very likely to stop taking the antidepressants they had been prescribed, according to a report by Archives of General Psychiatry, a JAMA Network publication. And, not surprisingly, they also cut back on other prescription drugs they were taking.

Depression affects about 13 percent of Medicare beneficiaries age 65 and older, many of whom have chronic physical conditions. Maintenance medication has been shown to prevent recurrent episodes of major depression.

However, the structure of the original Part D benefit, particularly the coverage gap, “imposes a serious risk for discontinuing maintenance antidepressant pharmacotherapy among senior beneficiaries,” the authors write in the study background.


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Under the original Part D, when total drug costs (the costs paid by both patient and the drug plan) reached an initial limit ($2,930 in 2012), coverage would stop completely. The patient was then responsible for paying the next $3,700 in drug costs until reaching the catastrophic limit, when coverage started again.

The 2010 Affordable Care Act (Obamacare) did something about the donut hole. This year, instead of paying for the entire cost of drugs while in the donut hole, people with Part D drug coverage are getting a 50 percent discount on name-brand drugs and a 14 percent discount on generics. These discounts will continue to increase over the next few years, until the doughnut hole is completely filled in by 2020.

The researchers, Yuting Zhang, Ph.D., and colleagues from the University of Pittsburgh, examined how older patients responded to the original coverage gap by conducting a study that used a 5 percent random sample of Medicare beneficiaries 65 years or older with depression (65,223 patients), who were enrolled in stand-alone Part D plans in 2007.

Being in the donut hole was associated with comparable reductions in the use of antidepressants, heart failure medications and anti-diabetics, the study reports.

Relative to a comparison group that had full coverage in the gap because of Medicare coverage or low-income subsidies, the no-coverage group reduced their prescription use -
   ● 12.1 percent for monthly antidepressants,
   ● 12.9 percent for heart failure drugs and
   ● 13.4 percent for oral anti-diabetics.

Beneficiaries with generic drug coverage in the gap reduced their monthly antidepressant prescriptions by 6.9 percent, a reduction attributable to reduced use of brand-name antidepressants, researchers note.

“If patients discontinue their appropriate medication therapy abruptly, they could be placing themselves at risk for medication withdrawal effects and for relapse or recurrence. If they do not notice any effects, they might decide not to resume taking antidepressants. Thus, a gap in drug coverage could place older adults in harm’s way, as a result of disruptions in appropriate maintenance antidepressant pharmacotherapy,” the authors conclude.

The study was supported by grants from the National Institute of Mental Health, the Agency for Healthcare Research and Quality, the University of Pittsburgh Central Research Development Fund and the University of Pittsburgh Medical Center Endowment in Geriatric Psychiatry.


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