Many patients with diabetes who reach the Medicare Part D drug coverage gap don't talk about drug costs with their doctors

Research Activities, April 2011, No. 368

Begun in 2006, Medicare Part D is the outpatient drug coverage benefit for Medicare enrollees. Under this benefit, once total drug costs reach $2,250, Medicare stops paying for drugs until individuals achieve an out-of-pocket maximum of $3,600. The plan includes an initial $250 deductible and 25 percent coinsurance until costs reach $2,250. A recent study found that once patients with diabetes enter this coverage gap, they are less likely to communicate with their physicians about drug costs.

The researchers used data from a survey of 1,458 Medicare beneficiaries with diabetes who had entered the drug coverage gap in 2006. All were part of the Translating Research into Action for Diabetes (TRIAD) study, which investigated diabetes care in managed care settings. The survey asked participants if they felt drug costs were important enough to mention them to their doctor. They were also asked if they ever talked with a doctor about their prescription drug costs and if they wanted doctors to consider costs when prescribing.

More than three-fourths (76 percent) of the group that had entered the drug coverage gap felt that communicating with doctors about medication costs was important. Yet, less than half of them (44 percent) actually reported having such a discussion. In addition, 80 percent of participants wanted their doctors to consider costs when prescribing medications for them. Nearly half (47 percent) said their physician had switched one or more prescriptions to a less expensive drug due to costs.

Physicians and diabetes educators should pay attention to these coverage gap issues and find ways to help patients with their prescription costs, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13902).

See "Patient-provider communication regarding drug costs in Medicare Part D beneficiaries with diabetes: A TRIAD study," by Julie A. Schmittdiel, Ph.D., Neil Steers, Ph.D., O. Kenrik Duru, M.D., and others in the BMC Health Services Research 10(164), pp. 1-7, 2010.

Current as of April 2011
Internet Citation: Many patients with diabetes who reach the Medicare Part D drug coverage gap don't talk about drug costs with their doctors: Research Activities, April 2011, No. 368. April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/research-activities/apr11/0411RA18.html