Medicare Coverage Gap May Cause Seniors to Forgo Antidepressants

Study also found less use of heart failure, diabetes drugs as out-of-pocket costs rose

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MONDAY, July 2 (HealthDay News) -- The Medicare Part D drug plan's gap in coverage -- often referred to as the "donut hole" -- has long been a concern, and a new study links it to cutbacks by seniors in the use of antidepressants and other medications.

An estimated 13 percent of seniors aged 65 and older suffer from depression, experts say. Antidepressants can stop depression from returning, but the Part D benefit -- especially the coverage gap -- "imposes a serious risk for discontinuing maintenance antidepressant pharmacotherapy among senior beneficiaries," the study authors found.

The study, published in the July issue of the Archives of General Psychiatry, also found less use of drugs prescribed to treat heart failure and diabetes among seniors who fell into the coverage gap.

While the 2010 Affordable Care Act is shrinking the "donut hole," it won't be fully closed until 2020.

In the study, researchers led by Yuting Zhang of the University of Pittsburgh looked at a random sample of more than 65,000 Medicare recipients aged 65 or older who were enrolled in stand-alone Part D plans in 2007.

During that year, seniors who reached a total of $2,400 in spending on prescription drugs lost further drug coverage until they reached the amount required for catastrophic care coverage ($3,850 in 2007) -- the coverage gap nicknamed the "donut hole."

Those who fell into the gap used fewer antidepressants, heart failure drugs and diabetes medications, the researchers found. Compared to other Medicare recipients who didn't fall into the gap (due to factors such as low-income subsidies), those who didn't have coverage took about 12 percent fewer monthly antidepressant prescriptions, about 13 percent fewer heart failure drugs and 13.4 percent fewer diabetes medications.

Discontinuing medications due to cost concerns could have long-term implications for depressed patients, the researchers noted in a journal news release.

"If patients discontinue their appropriate medication therapy abruptly, they could be placing themselves at risk for medication withdrawal effects and for relapse or recurrence," Zhang and colleagues wrote. "If they do not notice any effects, they might decide not to resume taking antidepressants. Thus, a gap in drug coverage could place older adults in harm's way, as a result of disruptions in appropriate maintenance antidepressant pharmacotherapy."

More information

Find out more about depression at the U.S. National Library of Medicine.

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