African Americans Suffer High Prescription Drug Costs Due to Medicare Part D Coverage Gap

Reaching the gap impacts access to medication and influences adherence.

Many patients in the United States have the advantage of subscribing to Medicare Part D to help with the cost of prescription drugs.

While the program helps those beneficiaries in need, however, many others in need fall under the plan’s coverage gap making it harder than ever to pay for their prescription drugs. In particular, the African American population falls under the category of beneficiaries unable to benefit from the program, especially those aged 65 years and older. Reaching or approaching the gap affects access to medication and influences whether those medications are taken as prescribed, researchers found in a recent study.

Louanne Bakk, an assistant professor in the University at Buffalo of Social Work, describes the difficulties associated with affording prescription drugs under Part D.

“Don’t assume that the existence of Part D means that people aren’t having a difficult time affording their meds. There are certain groups that continue struggling with prescription drug costs regardless of this federal benefit being in place,” said Bakk.

While studies have been conducted in the past to evaluate the coverage gap of the general population, Bakk’s research is the first to examine how race and gender relate to the coverage gap. The results have important implications for social workers who need to be mindful of the cost difficulties the gap creates and the potential resources that exist to get people through that period, according to Bakk.

The study evaluated the 2010 standard benefit and found that beneficiaries went into the coverage gap when their prescription drug spending reached $2,830. Beneficiaries would then pay 100% of their prescription drug costs until their additional prescription drug spending amounted to $4,550. The Affordable Care Act decreases the amount beneficiaries are responsible for when reaching or approaching the coverage gap; however, costs associated with this benefit threshold can still be problematic.

Reaching a point where out-of-pocket costs decrease significantly rarely happens, according to researchers. This is known as the catastrophic limit. People often can’t afford the medications due to the coverage gap and cease taking them. As a result, the catastrophic coverage benefit is never reached because their spending stops before the amount required is obtained.

“We’ve known that people in poor health or those with low incomes are more likely to stop taking their medication when they go into the gap, but as we look at this demographically, although there wasn’t a significant difference between males and females, we did find that older blacks are having a much harder time affording their meds than whites, and this difference is largely driven by the coverage gap,” Bakk said.

Assistance to ease the burden of these payments is difficult to find as well. The Low Income Subsidy Program, while available through Medicare, is only used by 50% of those who qualify for assistance. According to Bakk, this is due to a lack of awareness of the program.

However, this could also be due to the complexity of Medicare Part D. With more than 50 different enrollment options and benefits that change annually, it’s easy to see how patients can get confused when attempting to take advantage of different benefits of the program. Only 10% of beneficiaries are in the most cost-effective plan for their medication needs.

Patients who discontinue taking their medication put themselves at serious risk and increase the likelihood of needing medical care. This also increases the likelihood of an emergency room visit and the possibility of long-term hospitalization.

Bakk said that as policy discussions continue there is a critical need to recognize that some individuals are continuing to have difficulties. The elderly African American population suffers most according to Bakk’s study, and resources such as Low Income Subsidy and Elder Pharmaceutical Insurance Coverage program are available to help ease the burden of expensive prescription payments.

By taking advantage of the correct programs and educating oneself about the different opportunities available through Medicare, patients can start taking their medications regularly rather than discontinuing taking them because of high costs.

Bakk noted that social workers are the answer to solving the problem of patients not taking advantage of the appropriate programs.

“People who struggle can be linked to the resources they need and connected to the best plan based on their needs, making changes if necessary during the annual enrollment period in October and November,” she added.