The report shows that in 2006, 20% of Medicare Part D beneficiaries -- in fair or poor health -- skipped medications, cut pills in half, or avoided refilling prescriptions. Researchers blame Part D's benefit structure, which requires patients to share some of the cost of their drugs with the government.
The biggest part of that "cost-sharing" is Part D's coverage gap, known as the "doughnut hole." Medicare's basic drug benefit covers 75% of drug costs up to $2,510, after monthly premiums and a deductible. But coverage then stops completely until out-of-pocket costs reach $5,726.
"It's perhaps not that surprising given some of the peculiar structure of Part D," says Jeanne Madden, PhD, a Harvard University researcher who authored the study.
During debates in 2003 and 2004, lawmakers and administration officials, including President Bush, heralded the drug program as a safety net for seniors with high drug costs. Madden says the study suggests the program has not yet completely lived up to that billing.
"You get the impression that it's 'problem solved' now that Part D is in effect. But it doesn't really look that way," Madden tells WebMD.
Madden says after Part D came into effect in January 2006, Medicare patients in most income levels were less likely to have to cut back on basic needs like food and heating. But she described those declines as "modest."
Effects of the 'Doughnut Hole'
The study is published in The Journal of the American Medical Association. A second study in the journal concludes that six in 10 patients who got their coverage through a large Medicare managed care plan in Northern California did not know of the existence of the doughnut hole.
That study shows that beneficiaries were increasingly likely to know about the gap as their own drug spending went up. It also shows that 15% of patients did not adhere to doctors' orders concerning their drugs because of cost. Patients who didn't know about their coverage gap were more likely to skimp on drugs or cut back on other necessities than those who did.
"These beneficiaries are paying a higher price for this poor knowledge," says John Hsu, MD, director of the Center for Health Policy at Kaiser Permanente. "Those who don't know are less able to respond."
Hsu tells WebMD that the study was confined to Kaiser Permanente's managed care plan in Northern California. He said it likely underestimates the problem in the majority of Medicare patients who get their benefits through more loosely affiliated networks.
Judith Stein, executive director of the Center for Medicare Advocacy, says organizations like hers that are trying to educate seniors on Part D are stymied by the plan's complexity. Plans vary from state to state, and individuals are supposed to choose them based on their own drug and health needs.
"Really using and understanding Part D is beyond the resources of the few organizations that exist to teach and the tens of millions of beneficiaries who use it," Stein says.