Drug Coverage of Medicare Beneficiaries with Kidney Failure – Some Surprising Findings

Most covered by Medicare Plan D receive a low-income subsidy

Highlights• In 2007, 64% of Medicare beneficiaries with kidney failure participated in Medicare’s Part D prescription drug coverage program.• Of these Part D enrollees, 72% received financial assistance from the program. • Those who self-enrolled in Part D plans without financial assistance often chose more expensive coverage options.• 17% of Medicare beneficiaries with kidney failure lacked a known source of prescription drug coverage.

Newswise — Washington, DC (March 8, 2012) — The majority of Medicare beneficiaries with kidney failure participate in Medicare’s Part D prescription drug coverage program, and most of these receive a low-income subsidy from the program, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The study presents the most comprehensive description of drug coverage to date among Medicare beneficiaries with kidney failure.

More than 500,000 individuals in the United States have kidney failure. Most are covered by Medicare, which makes them eligible to voluntarily enroll in one of various Medicare Part D prescription drug coverage plans. Drug coverage is so important for kidney failure patients because they must often take a dozen or more different prescription medications.

“Enrollment in a Medicare Part D plan has the potential to reduce prescription drug costs for kidney failure patients and may make it easier for many to afford the medications they need,” said Benjamin Howell (Centers for Medicare & Medicaid Services).

Despite the importance of prescription medications for Medicare beneficiaries with kidney failure, little is known about how these patients choose and obtain drug coverage. To investigate, Howell and his colleagues analyzed drug coverage information for 87,184 kidney failure patients who were enrolled in Medicare in 2007.

Approximately 64% of Medicare beneficiaries with kidney failure were enrolled in Medicare Part D. Among these, 72% received financial assistance from the program due to low income (compared with 39% of beneficiaries without kidney failure who received such assistance).

Those without financial assistance preferred expensive comprehensive options without coverage gaps, likely because kidney failure requires intensive and consistent medication therapy.

The researchers also found that 9% of Medicare beneficiaries with kidney failure obtained retiree drug coverage from a former employer, 10% received coverage from another creditable source, and 17% lacked a known source of credible drug coverage. (Some may have obtained coverage from private sources not typically reported to Medicare.)

Many Medicare beneficiaries with kidney failure say the high costs of medications have prevented them from following their doctors’ orders. Therefore, more outreach is needed to ensure they obtain drug coverage and join the best plans for managing their disease and its complications without burdening them financially.

Study co-authors include Christopher Powers, PharmD, Diane Frankenfield, DrPH (Centers for Medicare & Medicaid Services); Eric Weinhandl (United States Renal Data System); and Wendy St. Peter, PharmD (United States Renal Data System and University of Minnesota, Minneapolis).

Disclosures: The authors reported no financial disclosures.

The article, entitled “Sources of Drug Coverage Among Medicare Beneficiaries with ESRD” will appear online at http://jasn.asnjournals.org/ on March 8, 2012, doi: 10.1681/ASN.2011070740.

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Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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