Seniors in “doughnut hole” may cut back on their antidepressants, heart and diabetes meds

Seniors in the gap of Medicare Part D prescription coverage are more likely than fully insured seniors to cut back on their antidepressants, as well as diabetes and cardiovascular medications, according to new research data.

In the study, published in this month’s issue of Archives of General Psychiatry, researchers observed a “significant reduction in all measures of use” of antidepressant drugs among seniors in the Medicare coverage gap compared to those who had full prescription drug insurance.

Seniors who self-adjust their regimens by reducing or skipping their antidepressant medications can create more complicated clinical problems, researchers noted. "If patients discontinue their appropriate medication therapy abruptly, they could be placing themselves at risk for medication withdrawal effects and for relapse or recurrence," the study summarized. "If they do not notice any effects, they might decide not to resume taking antidepressants."

Even more disturbing, seniors in the gap with chronic cardiac conditions and diabetes showed the same tendencies to reduce or skip medication refills, the study noted. Most seniors who have depression also have several other conditions, compounding the problem.

The current “doughnut hole” requires Medicare beneficiaries to cover 100% of drug costs once they reach $2,930. The coverage kicks in again at $4,700.  

Those with chronic diseases such as diabetes, CHF and depression are among the seniors most likely to accrue the prescription spending levels to reach the coverage gap.

The Accountable Care Act includes an incremental plan to close the coverage gap by 2020.