Eroding Gains from Part D Medicare

When Medicare was expanded in 2003, the expansion that established prescription drug coverage was called a “promise, a solemn promise, to America’s seniors.” Part D Medicare officially took effect in 2006, but still some seniors were afraid of falling into the infamous “doughnut-hole” coverage gap.

Initial Benefits of Part D

In Part D’s first few years, national data has shown that the program had helped seniors make progress with their prescription drugs. Overall, out of pocket costs decreased for medication, seniors took their medication more regularly, and were less likely to forego basics like food or heat in order to afford for their prescriptions.

One study recently published by the Harvard Medical School and University of Massachusetts shows that people who are more ill and need more medications are having significant problems with Part D Medicare. In 2005, before the beginning of Part D nearly fifteen percent of Medicare beneficiaries admitted that they would stop taking their medication, skipped or reduced dosages, or delayed refills for cost reasons. However, after the advent of Part D, the percentage of seniors engaged in this practice decreased down to nearly ten percent.

Similarly, the same pattern emerged when it came to forgoing basic needs, like food or heat, to pay for prescription drugs. In 2005, nine percent reported engaging in this practice, and after Part D the number dropped to four percent. But in the last three years the number of senior beneficiaries for Part D has once again started to skip their medications and sacrifice basic needs for their prescription drugs.

New Trends in Part D Care

In the last three years, the percentage of seniors engaged in risky medication practices or giving up basic needs in order to afford their medication is rising back up towards pre-Part D levels. In 2011, the number of seniors who would stop taking their medications or skip dosages increased back to 10.8%, and the percentage of people foregoing basic needs increased back up to 5.3%.

An even more disturbing trend is that the affordability of medication has eroded the most for the elderly that have the greatest needs. For Part D beneficiaries that have four or more chronic conditions like heart disease, hypertension, diabetes, stroke, cancer, pulmonary disease, and similar issues the percentage of seniors participating in risky medication habits or sacrificing basic needs has almost reached pre-Part D levels.

Eroding Gains in Part D Care

There are a few reasons why the gains are no longer as great for Part D Medicare. For seniors with multiple chronic issues, the co-pay costs of multiple medications can begin to add up. People with fixed incomes can struggle to pay bills and the costs of medication. These seniors are also the most likely to fall into the “doughnut hole” of coverage until it closes in 2020 through the Affordable Care Act.

Another reason for the decline in Part D gains are the changes being made within Medicare plans. Part D plans are covering fewer medications every year. In addition, Part D plans have also been implementing tier strategies for certain medications, requiring pre-authorization from doctors, and placing other restrictions on plans that make it more difficult to get the medication
that seniors need.