The advent of Medicare’s Part D drug plan introduced everyone to the concept of the “donut hole.” That’s the point at which prescription drug coverage ceases for a period during which the plan member pays full price. The gap closes when the patient has spent a set amount for drugs, and subsidies resume. As reported by Reuters Health, research has shown that this gap prompts seniors to stop taking medications for heart problems, diabetes and, now, depression.
According to the researchers of a new study published in the Archives of General Psychiatry, when these patients stop taking antidepressants, their risk of relapse increases. Such behavior, they said, “poses a serious risk.”
Once beneficiaries pay a deductible of a few hundred dollars, Part D drug plans usually cover 75 percent of drug costs until the threshold figure is reached. This year, for standard coverage, that amount is nearly $3,000. Then patients must shell out another $3,700 (amounts vary according to plan) before coverage resumes.
If the Affordable Care Act survives the current political upheaval, the donut hole will expire in 2020, when the legislation mandates that drug coverage be constant. But that’s a long time away, especially if you’re a senior citizen.
We’ve discussed how the insurance coverage options available to supplement Medicare are so confusing that seniors are less likely to enroll for additional coverage. But the study makes clear, however, that they are less likely to forgo their drugs if they have it.
The study involved more than 22,000 Medicare beneficiaries who had been diagnosed with depression and were prescribed antidepressants. Data was collected starting in 2007, the year after the Part D plan was initiated. Nearly 3,000 study subjects had supplemental insurance that filled the gap for generic drugs. Another 11,500 had complete coverage from other sources, including low-income subsidies. But more than 7,500 were stuck paying the gap amount.
Nearly 7 in 100 people who had generic drug gap coverage ceased taking their antidepressant meds, but more than 12 in 100 with no coverage did.
As the study notes, depression affects 13 in 100 Medicare beneficiaries 65 years or older. Many have additional chronic physical conditions. Treating and maintaining treatment of late-life depression with antidepressants prevents recurrent episodes of major depression. Caregivers generally recommend these patients take antidepressants for two years.
It’s a bad idea to stop taking these drugs cold turkey. As the lead researcher wrote, "If patients discontinue their appropriate medication therapy abruptly, they could be placing themselves at risk for medication withdrawal effects including include dizziness, gastrointestinal distress, disturbing dreams, fatigue and irritability] and for (depression) relapse or recurrence."
Although the study didn’t find that rates of hospitalization were higher for the no-gap coverage group than the others in the study, the depressed elderly population remains vulnerable to the Part D donut hole.
If you or a loved one is in this situation, help is available. Contact the manufacturer of the relevant drug—they often have coupons or rebate/subsidy programs for the financially pinched. That link also includes contact information for other prescription assistance organizations, as well as general resources for seniors. For general information about Medicare’s prescription drug coverage, link here.