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Study reveals seniors at risk for stopping medications after losing brand-name drug coverage

UH researcher conducts study as a Robert Wood Johnson Foundation Clinical Scholar

University of Hawaiʻi
Contact:
Chien-wen Tseng, MD
Department of Family Medicine and Community Health
Posted: Sep 13, 2006

A recent study found that over one in four seniors cut back on their use of medications after their health plan stopped covering brand-name drugs. This has implications for the 23 million elderly people enrolled in the new Medicare Drug Benefit plan, where some health plans are trying to bridge a "coverage gap" in the benefit by providing coverage for generic but not brand-name drugs. The gap occurs when seniors have spent $2,250 for drug costs, then lose all drug coverage and must pay the next $3,100 out-of-pocket until the beginning of the next calendar year when coverage begins again. Medicare expects four in ten seniors to fall into this coverage gap. "Generic-only" drug benefits are being considered as one way to help seniors during this period. This study shows that generic-only drug benefits, while better than no coverage, are not complete solutions to the coverage gap.

The study, published in the September 14 issue of the American Journal of Managed Care (AMJC), found that even when seniors retained coverage for generic drugs, the loss of brand-name drug coverage was sufficient to lead patients to cut back on their medications. Although many seniors (more than 25 percent) reported switching drugs to reduce costs, 28 percent of seniors still stopped or skipped medications. The decrease in medication use affected drugs for treating high cholesterol, pain, asthma, and depression among others. Two-thirds of the seniors reported difficulty paying for their prescriptions, and many others said prescription costs resulted in their not participating in enjoyable activities (43 percent), having difficulty paying rent or other bills (24 percent), not getting other medical care (15 percent), and/or having to borrow money or get help paying for medications (13 percent).

Dr. Chien-Wen Tseng, currently an Assistant Professor at the University of Hawaiʻi Department of Family Medicine and Community Health and a researcher at the Pacific Health Research Institute, conducted the study with UCLA and RAND investigators Drs. Mangione, Keeler, and Brook while she was a UCLA Robert Wood Johnson Clinical Scholar.

Dr. Tseng says that this study shows that, "Physicians and health plans must actively help Medicare patients find ways to adjust to a switch from brand-name to generic-only drug benefits. Health plans are required by Medicare to provide any benefits during the coverage cap, and providing some coverage for generic drugs is much better than no coverage. However, insurers, physicians, and Medicare must realize that these ʻgeneric-only‘ drug benefits are not complete solutions to the coverage gap."

Although not addressed in this study, Dr. Tseng feels that, "Patients and physicians have to make the best use that they can of generic drugs. If seniors choose to stick to brand-name drugs, they may find themselves running out of drug coverage before the end of the year."

Dr. Tseng‘s current study, funded by the Robert Wood Johnson Foundation, has developed a paper and web-based "smart prescribing guide" that helps physicians identify which drugs are covered by most formularies in Hawaiʻi. "Doctors want to help," she said, "but it‘s hard for them to know which drugs are covered, which are brand-name or generic, or how much drug benefit a senior has left."

In Hawaiʻi, the issue of affordable medications is also important for the nearly 204,000 people, or 20% of the population, who are believed to be without drug benefits. Although health plans recognize the importance of providing drug benefits, the cost of such benefits can be a problem. The two leading health plans in Hawaiʻi, HMSA and Kaiser, report that drug expenditures for their members doubled in the last five years and are expected to double again in the next five years. The need to make prescription medications affordable for patients is a critical health issue for Hawaiʻi as well as nationally.

The authors of the study are Dr. Chien-Wen Tseng who was a UCLA Robert Wood Johnson Clinical Scholar when this research was conducted and is currently an Assistant Professor of Family Medicine and Community Health at the University of Hawaiʻi‘s John A. Burns School of Medicine and an investigator at the Pacific Health Research Institute; Dr. Robert H. Brook, Professor of Medicine, David Geffen School of Medicine at UCLA; Professor of Health Services, UCLA School of Public Health; director, UCLA Robert Wood Johnson Clinical Scholars Program; and Director of RAND Health; Emmett Keeler, Ph.D, Adjunct Professor of Health Services, UCLA School of Public Health and senior mathematician, RAND Health; Beth Waitzfelder, Ph.D, Investigator at the Pacific Health Research Institute, and Dr. Carol Mangione, Professor of Medicine, David Geffen School of Medicine at UCLA. The study was funded by the Robert Wood Johnson Foundation Clinical Scholars Program, the American Academy of Family Physicians, and the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, National Institutes of Health.