Medco Study: Medicare Coverage Gap Leads To Drop Off In Drug Therapy For High Cholesterol Patients; Brand Medication Users At Greatest Risk
April 16, 2017
Seniors
battling high cholesterol are more likely to stop taking their medications
once they reach the Medicare Coverage Gap, a result that may put them at
higher risk for heart attack and stroke. New research by Medco Health
Solutions, Inc. (NYSE: MHS) finds that Medicare beneficiaries prescribed
cholesterol lowering statins are nearly twice as likely to abandon their
cholesterol-fighting medications when they reach the Coverage Gap, or donut
hole, and become responsible for paying the entire cost of their
medications, than they are in the initial phase of the benefit when the
cost of the medication is covered. Studies show that these medicines -
known as statins - significantly reduce the risk of heart attack and stroke
for patients with high cholesterol.
The Medco analysis further reveals that Medicare Part D recipients
prescribed branded cholesterol-lowering statins are most at risk since they
are more likely to stop taking their medications than those using a generic
drug. The study shows that during 2007, the rate of patients who suspended
generic statin treatment was 20 percent lower than those on a brand-name
medication.
"This research confirms the concerns related to patient health in the
Coverage Gap, and also validates the positive impact generics have on
helping patients remain compliant with their medications," said Dr. Woody
Eisenberg, chief medical officer of Medco Retiree Solutions(TM). "Taking
statins regularly can help prevent serious cardiovascular problems, so it's
important that patients remain faithful to their therapies throughout the
year. Using generics can help seniors delay or possibly even avoid hitting
the Gap and increases the likelihood that they'll continue to take these
essential medications."
According to the Medco research, which included non-low income subsidy
beneficiaries across all phases of the Medicare benefit in 2007, 22 percent
of recipients reached the Gap by July 2007 and by December 2007 exactly
half were either in the Gap or had such high costs that they had proceeded
to the Catastrophic Coverage phase of the benefit.
During 2007, the Medicare Part D Coverage Gap took effect when
beneficiaries' total drug costs reached $2,400. Beneficiaries were then
responsible for paying 100 percent of their drug costs until total costs
reach $5,451, when Catastrophic Coverage begins to cover 95 percent of a
beneficiary's drug costs.
Generic Use Surges in the Gap
The analysis also reveals that reaching the Coverage Gap dramatically
stimulates the use of generics among all Medicare recipients. During the
initial phase of the benefit, when the plan provides drug coverage,
one-third of the medications used daily by beneficiaries were generics and
two-thirds were brand-name drugs. Once beneficiaries reached the Gap and
were responsible for the full cost of the drug, those numbers flip -
generic usage rises to 71 percent and brand-name use falls to 29 percent.
"Upon reaching the Gap, Medicare beneficiaries become acutely aware of
the cost differences between brand-name and generic drugs and most make the
switch. Unfortunately, by not using generics in the initial phase of the
benefit, they put themselves at greater risk for hitting the Coverage Gap
much faster," said Eisenberg.
The cost difference between generics and brand name drugs for patients
in the Coverage Gap can be significant. In the initial covered phase of the
benefit, the average cost of 30 days of branded therapy of lipid-lowering
medications for standard eligible patients is $30.89 versus $7.06 for a
generic. In the Coverage Gap, it increases to $88.44 for brands and $16.14
for generics.
Bridging the Communication Gap
According to a 2008 Medco survey of 400 Medicare beneficiaries, 78
percent of respondents said they felt that it was important for their
health plan to communicate money-saving tips to help delay reaching the
Gap. In addition, a majority of respondents indicated that programs
alerting them to their proximity to the Gap were significant factors in
their decision to re-enroll with the plan.
Recognizing the importance of educating enrollees about the Coverage
Gap, Medco has introduced a Coverage Gap communications program that alerts
its Prescription Drug Plan members and specific health plan beneficiaries
through mailings and outbound phone calls of their proximity to the Gap
long before they reach it. Additionally, any time one of these members
contacts a customer service representative for any reason, a Coverage Gap
status update is provided. To increase the likelihood that physicians will
prescribe a generic drug rather than a brand, Medco offers members
prescription forms they can bring to their physician or contacts the doctor
on the member's behalf to discuss generic alternatives that can lower the
member's costs.
Medco's specialist pharmacists, who are dedicated to the treatment of
patients with specific chronic and complex diseases such as diabetes and
heart disease, counsel members on the importance of compliance and utilize
integrated data systems to identify patients who are not properly adhering
to their medication regimens.
About Medco
Medco Health Solutions, Inc. (NYSE: MHS) is the nation's leading
pharmacy benefit manager based on its 2007 total net revenues of more than
$44 billion. Medco's prescription drug benefit programs, covering
approximately one-in-five Americans, are designed to drive down the cost of
pharmacy health care for private and public employers, health plans, labor
unions and government agencies of all sizes, for individuals served by the
Medicare Part D Prescription Drug Program, and those served by Medco's
specialty pharmacy segment, Accredo Health Group. Medco, the world's most
advanced pharmacy(R), is positioned to serve the unique needs of patients
with chronic and complex conditions through its Medco Therapeutic Resource
Centers(R), including its enhanced diabetes pharmacy care practice through
the Liberty acquisition. Medco is the highest-ranked independent pharmacy
benefit manager on the 2008 Fortune 100 list. On the Net:
medcohealth.
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is defined in the Private Securities Litigation Reform Act of 1995. These
statements involve risks and uncertainties that may cause results to differ
materially from those set forth in the statements. No forward-looking
statement can be guaranteed, and actual results may differ materially from
those projected. We undertake no obligation to publicly update any
forward-looking statement, whether as a result of new information, future
events, or otherwise. Forward-looking statements in this press release
should be evaluated together with the risks and uncertainties that affect
our business, particularly those mentioned in the Risk Factors section of
the Company's Annual Report on Form 10-K and Quarterly Reports on Form 10-Q
filed with the Securities and Exchange Commission.
Medco Health Solutions, Inc.
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