A new Kaiser Foundation sponsored study uses an IMS data set to look at how many seniors hit the donut hole and what happens when they do. It turns about about 14 percent go through the point where seniors have to spend up to $3850 of their own money on drugs. That's about the same as in 2006 according an independent study conducted by IMS itself if you take away seniors who did not spend anyting on prescription. Adding in seniors that spent nothing you get about 6 percent hitting the donut hole.
The Kaiser folks wiped out the seniors who spent nothing to plump up the bottom line figure. Why is one level of spending any less or more important than any other. Indeed, when doing weighing of distributions you have to add those folks in so that decision was a political one to say the least, not a methodological imperative. Six percent is still 3 million people. And it doesn't take away from the fact that both studies found people who hit the hole -- up to one in 10 -- stopped taking their meds for diabetes, depression, Alzheimer's, hypertension and that more than half did not restart after getting catastrophic coverage.
The biggest problem with the Kaiser study is that it does not compare the behavior of seniors with and without gap coverage indeed the authors admit:
"The IMS database does not provide sufficient information about Part D plans (in particular, it does not distinguish among the multiple plan offerings of a single sponsor) to allow for identification of the small share of enrollees in plans with gap coverage, which prevents us from excluding them from the analysis."
http://www.forbes.com/forbeslife/health/feeds/hscout/2008/08/21/hscout618675.html
Small share? Actually over 60 percent are enrolled in plans in gap coverage.
The interesting policy question is what aren't more seniors choosing plans with gap coverage over the lowball premium plans?
A further policy question is whether encouraging seniors to switch from an existing medicine in a class -- generic or not -- to another drug is wise. Gail Shearer of Consumer Union sent a letter to the NY Times arguing that "taking the cholesterol-lowering drug simvastatin (the generic of Zocor) instead of Lipitor saves about $60 to $70 a month. Likewise, many people with acid reflux disease can save $150 to $200 a month by taking nonprescription omeprazole (the generic of former best-selling Prilosec) instead of the much-advertised Nexium. People should raise the issue of drug prices with their doctors to make sure they get prescriptions for medicines they can afford."
http://www.nytimes.com/2008/09/07/opinion/l07Medicare.html?scp=1&sq=gail%20shearer&st=cse
I am glad she urged people to raise the issue with doctors because switching drugs is something people should not do on their own. Direct to consumer information -- from any source -- should start with patient VALUE in the long term and work from there. Off the cuff money saving comments can be dangerously expensive otherwise.
The Kaiser folks wiped out the seniors who spent nothing to plump up the bottom line figure. Why is one level of spending any less or more important than any other. Indeed, when doing weighing of distributions you have to add those folks in so that decision was a political one to say the least, not a methodological imperative. Six percent is still 3 million people. And it doesn't take away from the fact that both studies found people who hit the hole -- up to one in 10 -- stopped taking their meds for diabetes, depression, Alzheimer's, hypertension and that more than half did not restart after getting catastrophic coverage.
The biggest problem with the Kaiser study is that it does not compare the behavior of seniors with and without gap coverage indeed the authors admit:
"The IMS database does not provide sufficient information about Part D plans (in particular, it does not distinguish among the multiple plan offerings of a single sponsor) to allow for identification of the small share of enrollees in plans with gap coverage, which prevents us from excluding them from the analysis."
http://www.forbes.com/forbeslife/health/feeds/hscout/2008/08/21/hscout618675.html
Small share? Actually over 60 percent are enrolled in plans in gap coverage.
The interesting policy question is what aren't more seniors choosing plans with gap coverage over the lowball premium plans?
A further policy question is whether encouraging seniors to switch from an existing medicine in a class -- generic or not -- to another drug is wise. Gail Shearer of Consumer Union sent a letter to the NY Times arguing that "taking the cholesterol-lowering drug simvastatin (the generic of Zocor) instead of Lipitor saves about $60 to $70 a month. Likewise, many people with acid reflux disease can save $150 to $200 a month by taking nonprescription omeprazole (the generic of former best-selling Prilosec) instead of the much-advertised Nexium. People should raise the issue of drug prices with their doctors to make sure they get prescriptions for medicines they can afford."
http://www.nytimes.com/2008/09/07/opinion/l07Medicare.html?scp=1&sq=gail%20shearer&st=cse
I am glad she urged people to raise the issue with doctors because switching drugs is something people should not do on their own. Direct to consumer information -- from any source -- should start with patient VALUE in the long term and work from there. Off the cuff money saving comments can be dangerously expensive otherwise.
