Medicare drug benefit could mean savings for patients with chronic conditions

March 1, 2006

Depending on the condition, average expected savings range from approximately $1,000 per year to more than $1,800 per year.

WASHINGTON, D.C.-Medicare beneficiaries with chronic conditions are likely to save money, perhaps a significant amount, if they enroll in the right Medicare Part D coverage plan, according to a recent report.

"This may not be the case for every Medicare beneficiary, but we encourage all potential enrollees to learn as much as they can about the new drug benefit and then make an informed decision," says Myrl Weinberg, president, National Health Council. The National Health Council released the report, "Savings from the Medicare Drug Benefit for Beneficiaries with Chronic Conditions," which consisted of an analysis of cost data from the Centers for Medicare and Medicaid Services conducted by The Lewin Group.

The scope of the study looked only at beneficiaries with common chronic conditions (Alzheimer's disease, arthritis, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, mental disorder, osteoporosis and Parkinson's disease) who face a decision whether to enroll in the Medicare drug benefit (i.e., excluding those automatically enrolled in the benefit and those with employer-based creditable drug coverage) and determine what impact the new Medicare prescription drug plan might have. The council's core membership comprises 50 national patient groups that collectively represent about 100 million people with chronic conditions and disabilities. Also included in this population are millions of Medicare beneficiaries. The study showed that:

INFORMATION FOR EXECUTIVES

Two other key pieces of information might be of interest to managed care executives, according to Weinberg.

"First, consider the large number of Medicare beneficiaries with one or more chronic conditions," she says. Eighty-six percent of the Medicare beneficiaries studied in the report had at least one chronic condition.

And second, Weinberg says, there is the potential to achieve greater compliance with treatment regimes within this population as medications become more affordable.

"Many Medicare beneficiaries decrease the dosages of their medications or stop taking them altogether because they cannot afford them," she says.

AFFORDABILITY IS A FACTOR

The proportion of elderly, chronically ill Medicare beneficiaries without supplemental private insurance that had problems affording prescription drugs rose from 12.4% to 16.4% between 2001 and 2003, according to the Community Tracking Study Household Survey, 2001 and 2003, cited in a May 2005 report published by the Center for Studying Health System Change.

"What this does is flood the healthcare system with people in need of emergency care for their chronic conditions and other types of acute care that could have been avoided and are ultimately more expensive than costs associated with consistent, ongoing care for patients with chronic conditions," Weinberg says.

"All chronic conditions should be viewed as important by the healthcare community," Weinberg says. "By investing now in consistent, comprehensive treatment, we can prolong health, improve quality of life and save money in the long term."