Medicare Part D: challenges for dialysis patients. Part 1.

Area of Science:

• Nephrology
• Health Policy
• Pharmaceutical Economics

Background:

• Dialysis patients incur high prescription drug costs, exceeding those of general Medicare beneficiaries.
• This financial burden may increase vulnerability to Medicare Part D policy-related issues.

Purpose of the Study:

• To identify specific problems dialysis patients encounter with Medicare Part D.
• To assess the impact of Part D policies on medication access and adherence for this population.

Main Methods:

• An online survey was distributed to dialysis social workers nationwide.
• Data were collected from 184 social workers representing 14,200 dialysis patients between January and October 2010.

Main Results:

• High-cost medications like Lanthanum carbonate, sevelamer carbonate, and cinacalcet faced the most significant Part D restrictions.
• 17% of social workers reported frequent patient unawareness of Part D coverage, and 54% noted up to 20% of patients lacked prescription drug insurance.
• Patients in the coverage gap altered medication behavior (skipped doses, reduced frequency) and faced higher out-of-pocket costs, potentially leading to reduced medication use.

Conclusions:

• Medicare Part D presents substantial barriers for dialysis patients, affecting medication access and adherence.
• Changes in medication-taking behavior due to coverage gaps and costs require further investigation for potential impacts on healthcare utilization.
• Anticipated policy shifts, including the 2014 inclusion of bone and mineral disorder medications in the dialysis bundle, may further influence patient access to essential therapies.