Antidepressants 'Fall' Through Doughnut Hole (CME/CE)

MedPageToday, 2012

The is the the coverage gap in Medicare where beneficiaries must pay the full cost of drugs until they meet a certain level, at which point Medicare coverage kicks back in.
In 2012, most Medicare Part D enrollees reach the doughnut hole after they spend $2,930 on drug copays and deductibles; they then have to pay 100% of costs until they spend $4,700.
Treating late-life depression with antidepressants has been shown to reduce episodes of major depression, and Medicare Part D covers depression drugs.
Zhang and colleagues used data from a random 5% sample of fee-for-service Medicare beneficiaries who were enrolled in Part D plans in 2007.
From that data sample, researchers identified seniors who had been diagnosed with depression and excluded those with bipolar disorder or schizophrenia.
Researchers then compared drug adherence (based on medication use, mean number of prescriptions filled per month, and monthly pharmacy spending) in seniors with full Medicare drug coverage and in seniors who were footing their entire drug bill because they were in the doughnut hole.
Having a gap in drug coverage was associated with a significant reduction in all measures of use among those with no coverage in the doughnut hole.
The doughnut hole group reduced the number of monthly prescriptions by 12.1% compared with a group with full Part D coverage.
Most of that reduction was for brand-name antidepressants, which are more expensive than their generic counterparts.
The average Medicare patient with depression also has at least four other coexisting conditions, such as hypertension, heart failure, and diabetes, and the researchers found adherence to drugs for those conditions also was affected by being in the doughnut hole.
Patients in the doughnut hole reduced their monthly use of heart failure drugs by 12.9% and anti-diabetics by 13.4%, relative to the group with full coverage.