Doctors brace for fallout as seniors hit gap in Medicare drug coverage

Physicians worry that some patients will skip medications and end up in the hospital.

By Beth Wilson, AMNews correspondent. Oct. 23/30, 2006.

Virgilio Licona, MD, fears the tough choices many patients will encounter once they are forced to pay out of pocket for prescriptions previously covered by Medicare Part D.

"They are going to have to make the decision between food, gas, rent and their medications," said Dr. Licona, a family physician practicing at Salud Family Health Center in Brighton, Colo. "That's scary."

About 3 million seniors are expected to reach a gap in their Medicare Part D prescription coverage before the end of the year, estimates America's Health Insurance Plans. About 38 million Medicare beneficiaries have drug coverage through a variety of sources, including stand-alone Part D plans, Medicare managed care plans, their employers and other federal programs.

Dr. Licona and many other physicians across the country are bracing themselves for questions from patients who hit the coverage break and for the fallout from the difficult decisions seniors might have to make.

Although AHIP officials predict the number of affected beneficiaries is less than the 3.4 million to 6.9 million originally projected by various groups, many physicians say the underlying cost to the health care community and society, overall, will be significant.

Dr. Licona, for example, said many of his patients facing the gap are on fixed incomes with little wiggle room. Some, he knows, will choose to go without medications.

As their conditions worsen, many of them will wind up in the emergency department or make more frequent and lengthier visits to hospitals, Dr. Licona said. "This cost will be enormous, and it won't be identified as being connected to Part D."