Medicare Part D cardiovascular patients are much more likely to stray from their medication regimen when they enter the "doughnut hole" coverage gap, a CVS Caremark research collaboration found.


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CVS: 'Doughnut hole' spurs nonadherence among CV patients

April 18th, 2012

WOONSOCKET, R.I. – Medicare Part D cardiovascular patients are much more likely to stray from their medication regimen when they enter the "doughnut hole" coverage gap, a CVS Caremark research collaboration found.

CVS Caremark said late Tuesday that Part D patients with no financial assistance while in the doughnut hole were 57% more likely to discontinue their cardiovascular medications than beneficiaries with consistent drug coverage. The study found no increase in short-term negative health issues during the coverage gap, but researchers noted that the long-term health impact of nonadherence is unclear.

The study — titled "Beneficiaries with Cardiovascular Disease and the Part D Coverage Gap" and published in the journal Circulation: Cardiovascular Quality and Outcomes — was conducted by researchers from Harvard University, Brigham and Women's Hospital and CVS Caremark. They examined prescription drug use for cardiovascular conditions such as hypertension, high cholesterol, atrial fibrillation, congestive heart failure and cardiovascular disease among more than 122,000 Medicare beneficiaries who reached the Medicare Part D doughnut hole in 2006 or 2007.

"This study is part of our ongoing research collaboration with Harvard and Brigham and Women's Hospital to help better understand those factors that can improve pharmacy care," Troy Brennan, executive vice president and chief medical officer at CVS Caremark, said in a statement. "The Affordable Care Act incrementally eliminates the doughnut hole by 2020, but until that time we want to make sure beneficiaries are making the best decisions to promote good health.

"For our part, we will continue to advocate for plan strategies that promote the use of low-cost medications, because cost remains a big issue in helping patients stay on their medications as directed," add Brennan, who heads the research collaboration.

Cardiovascular drugs represent the largest portion of spending (25%) and prescription volume (36%) in the Part D program, according to the research team.

Researchers concluded that cost-sharing mechanisms like the coverage gap disrupted the beneficial effects of drug coverage expansion under Part D for elderly beneficiaries with cardiovascular conditions, instead prompting them to discontinue their medications more frequently than beneficiaries with stable drug coverage. The study also found that beneficiaries were no more likely to switch to generic medications during the doughnut hole.

"Consistent with other research on the impact of the Medicare Part D coverage gap on medication adherence, we found that exposure to 100% of drug costs in the gap led to abrupt discontinuation of essential cardiovascular medications, even among those with cardiovascular conditions who might experience more immediate consequences as a result of drug discontinuation," explained study lead author Jennifer Polinski of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School.

"While the results did not demonstrate any short-term health issues as a result of this dramatic drop-off in medication adherence," Polinski stated, "it is not clear whether coverage gap-related lapses in financial assistance for drugs affects patient health outcomes for this high risk population over the long term."

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