Navigating insurance coverage, especially with recent changes to prescription drug plans, can be confusing and stressful. This may be true because of increasing out-of-pocket medical costs.
A 2017 Agency for Health Care Quality (AHCQ) study found that 11.5% of low-income adults with 2 or more chronic conditions enrolled in high-deductible health plans pay 10% of their income on out-of-pocket costs for brand name medicines. Additionally, on average these low-income adults with 2 or more chronic conditions mean family out-of-pocket expenditure on brand name drugs ranges from $405-$1020.
One reason patient out-of-pocket spending has grown is a change in how health insurance is designed and how pharmaceutical benefits are managed. These changes in benefit design make affordability significantly more challenging for some patients, especially if they enter a coverage gap.
What are coverage gaps?
Coverage gaps occur when a patient has reached the maximum amount for covered drugs on a drug plan like Medicare Part D or commercial high deductible plans. When a person enters the coverage gap, they may face a sudden increase in cost which can make it hard to afford their medications.
Some people in a coverage gap may choose not to take their medication as prescribed to extend their current supply. This practice can be incredibly dangerous in the long term, especially for patients taking blood thinners.i
The danger of skipping blood thinners
According to a study published in Circulation, the official journal of the American Heart Association, patients with atrial fibrillation (or heart arrhythmia) decreased their use of oral anticoagulants (a category of blood thinners) by 20% when entering the coverage gap. Even after exiting the coverage gap, these patients did not increase their intake. In fact, they continued to decrease their medication refills.ii
Missing a dose of a blood thinner may lead to several complications, including heart attack and stroke.iii While a patient may not experience these medical complications immediately, missing doses could increase their risk.
Managing your health conditions can be time-consuming, exhausting and stressful, but you shouldn’t have to choose between your medication and providing for yourself or your family. If you’re on a blood thinner, there are solutions available that may be able to help, including options for lower out-of-pocket costs for patients who have fallen into a coverage gap and qualify for assistance.
“A coverage gap is a real issue and I don’t think people know about it until they are in it,” said Dale P., a blood thinner user who was previously in a coverage gap.* “I’m retired with a fixed income and it’s been difficult to afford paying for all the drugs that I take … Sometimes I have to choose whether I can fill my prescription this month.”
If you’re on a blood thinner while on Medicare Part D or another prescription drug plan and have fallen into a coverage gap, you may qualify for lower-cost medication options. By visiting FeelingWhen.com, you can explore an option that, for those who are eligible, can help you keep your blood thinner prescription routine on track and help to reduce the stress and confusion associated with a coverage gap.
i Financial Burdens of Out-of-Pocket Prescription Drug Expenditures under High-Deductible Health Plans https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500984/pdf/11606_2020_Article_6226.pdf; Date Accessed: March 7, 2022
ii Self-reported Medication Adherence and Cardiovascular Events in Patients With Stable Coronary Heart Disease: The Heart and Soul Study. (2007). JAMA Internal Medicine. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/413019; Date Accessed: March 2, 2022
iii Use of Oral Anticoagulants for Atrial Fibrillation Drops by 20% Upon Entering the Medicare Coverage Gap. (2021). Circulation. https://www.ahajournals.org/doi/abs/10.1161/circ.144.suppl_1.9289?af=R&; Date Accessed: March 2, 2022
*Patient verbatim response from phase two research testing, November 1, 2021. Insight Consulting Group