Repeat experience with the doughnut hole in Medicare Part D: when the doughnut hole becomes a tunnel

Abstract

Objective: To describe the proportion of elderly Medicare advantage prescription drug plan (MAPDP) enrollees who meet or exceed the Medicare Part D doughnut hole (DH) entry threshold in 2 consecutive years and which characteristics put them at risk for repeated DH entry.

Sample: One cohort of MAPDP enrollees ≥65 years of age with at least 1 month of eligibility in both 2006 and 2007, and a second cohort of enrollees with at least 1 month of eligibility in both 2007 and 2008.

Methods: Descriptive statistics were used to compare characteristics of MAPDP enrollees who attained the DH entry threshold in 2 consecutive years with MAPDP enrollees who attained this threshold in only 1 or neither of these years. Adjusted odds ratios of the likelihood of repeatedly entering the DH were obtained using multivariate generalized estimating equations.

Results: The percent of MAPDP enrollees who attained the DH entry threshold in 2 consecutive years was low: 7% of enrollees in the 2006/2007 cohort and 6% of the 2007/2008 cohort. Likelihood of repeatedly entering the DH compared with not entering the DH in 2 consecutive years was significantly higher among MAPDP enrollees with multiple comorbidities and who were ≥74 years of age or female.

Conclusions: A small subset of Medicare beneficiaries with significantly increased risk of repeatedly entering the DH may receive financial protection from closing of the DH as enacted in recent healthcare reform.