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Dr. Kim Mulvihill ReportingA new study found limits on prescription drug benefits may cause real harm to patients. For many, the new medicare drug plan is a plus.
"For cholesterol control drugs, it's about three dollars a day if you have to pay for it yourself."
But for some beneficiaries, they could soon be facing what's called the doughnut hole. That hole is a planned gap in coverage, where if you use a lot of prescription drugs, at a certain point you pay the full cost of those drugs, up to thousands of dollars, before coverage resumes.
Nearly 7 million medicare patients eligible for plan d are expected to fall into the donut hole. A new study suggests their predicament is not the best way to practice medicine.
John Hsu, M.D., Kaiser Division of Research: "When there isn't adequate coverage, it can really cause clinical harm."
Dr. Hsu is lead author of the study. His team studied seniors who in 2003 had annual drug benefit caps, and then compared them to seniors who had no limits. There was good news.
Dr. Hsu: "We found that having the drug benefit cap reduced spending as expected. People weren't just decreasing only discretionary drugs they were also decreasing medications they really needed."
Patients with caps ended up in the ER more often, the hospital more often and were more likely to die because they decreased the use of important drugs.
Dr. Hsu: "Especially medications they needed for chronic diseases, things that were prescribed by their doctors, things that helped keep their blood pressure under control, their cholesterol under control, keep their diabetes under control, and as a result there was real harm."
While this research did not study the new medicare program, Dr. Hsu believes plans under part d should be monitored.
Dr. Hsu: "Are these plans do they do anything we hope they wouldn't do and we didn't expect them to do."
The rise in overall health care costs from year to year is attributable to expensive prescription drugs. This new study found limiting drug coverage failed to save money on overall healthcare costs.
