ESRD patients face serious challenges as they navigate the new prescription drug program.
Patients with end-stage renal disease (ESRD) are facing substantive challenges with the onset of the new Medicare Part D prescription drug program, a new survey by the American Kidney Fund (AKF) reports.
Research shows that patients with kidney failure reach the coverage gap, or “doughnut hole,” phase of the program faster than other beneficiaries because their medication costs are virtually double those of the average Medicare recipient.
Under the legislation enacted in January 2006, the Medicare Part D drug program requires beneficiaries to meet a small deductible with a monthly premium. Medicare will cover 75% of the cost, on average, until members reach their benefit limit ($2,400 in 2007). At this point, they reach the coverage gap or “doughnut hole,” wherein no additional assistance is provided until expenses reach $5,451. From that point on, Medicare Part D will pay 95% of their drug costs.
At issue is the percentage of the kidney patient population that does not break through the gap to reach the catastrophic ceiling, and the subsequent impact this has on renal care. The AKF survey canvassed roughly 15% of the ESRD population (58,000 patients) at dialysis and transplant centers nationwide. Almost 60% have trouble paying for their medications while in the coverage gap, and may resort to cutting dosages or discontinuing medications altogether.
Additionally, patients in various stages of renal failure are finding several other aspects of the plan formidable, according to the nearly 700 nephrology social workers who were surveyed nationwide.
Besides the premium and cost sharing issues, enrollment is proving challenging. A large number of kidney failure patients are unaware of the Part D program. Those who are aware face numerous administrative hassles during the enrollment phase. Navigating through convoluted Web sites with formularies that may or may not match specified medication regimens often proves daunting.
Survey results, which were analyzed by an independent agency in late 2006, show that 92% of ESRD patients experience formulary challenges. In addition, more than one third of the ESRD patients enrolled in Medicare’s Part D have trouble getting pre-authorization in order to receive medications that are on their plan’s formulary.
Dialysis patients on maintenance drugs and vitamin supplements, in combination with bone disease medications, find themselves strapped as they try to juggle the fluctuating medication tiers within their plan’s formulary, as well as their own changing needs in drug therapy.
In response, the AKF has set up a Medicare Part D Grant program for Prescription Bone Disease Medications. Eligible dialysis patients in the U.S. can apply for up to $2,000 per year in
prescription assistance for the cost of bone disease medications. The AKF plans to extend its grant program to assist with other renal medications.