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Medco Study: Medicare Coverage Gap Leads To Drop Off In Drug Therapy For High Cholesterol Patients; Brand Medication Users At Greatest Risk

April 16, 2017

Seniors battling high cholesterol are more likely to stop taking their medications once they reach the Medicare Coverage Gap, a result that may put them at higher risk for heart attack and stroke. New research by Medco Health Solutions, Inc. (NYSE: MHS) finds that Medicare beneficiaries prescribed cholesterol lowering statins are nearly twice as likely to abandon their cholesterol-fighting medications when they reach the Coverage Gap, or donut hole, and become responsible for paying the entire cost of their medications, than they are in the initial phase of the benefit when the cost of the medication is covered. Studies show that these medicines - known as statins - significantly reduce the risk of heart attack and stroke for patients with high cholesterol.

The Medco analysis further reveals that Medicare Part D recipients prescribed branded cholesterol-lowering statins are most at risk since they are more likely to stop taking their medications than those using a generic drug. The study shows that during 2007, the rate of patients who suspended generic statin treatment was 20 percent lower than those on a brand-name medication.

"This research confirms the concerns related to patient health in the Coverage Gap, and also validates the positive impact generics have on helping patients remain compliant with their medications," said Dr. Woody Eisenberg, chief medical officer of Medco Retiree Solutions(TM). "Taking statins regularly can help prevent serious cardiovascular problems, so it's important that patients remain faithful to their therapies throughout the year. Using generics can help seniors delay or possibly even avoid hitting the Gap and increases the likelihood that they'll continue to take these essential medications."

According to the Medco research, which included non-low income subsidy beneficiaries across all phases of the Medicare benefit in 2007, 22 percent of recipients reached the Gap by July 2007 and by December 2007 exactly half were either in the Gap or had such high costs that they had proceeded to the Catastrophic Coverage phase of the benefit.

During 2007, the Medicare Part D Coverage Gap took effect when beneficiaries' total drug costs reached $2,400. Beneficiaries were then responsible for paying 100 percent of their drug costs until total costs reach $5,451, when Catastrophic Coverage begins to cover 95 percent of a beneficiary's drug costs.

Generic Use Surges in the Gap

The analysis also reveals that reaching the Coverage Gap dramatically stimulates the use of generics among all Medicare recipients. During the initial phase of the benefit, when the plan provides drug coverage, one-third of the medications used daily by beneficiaries were generics and two-thirds were brand-name drugs. Once beneficiaries reached the Gap and were responsible for the full cost of the drug, those numbers flip - generic usage rises to 71 percent and brand-name use falls to 29 percent.

"Upon reaching the Gap, Medicare beneficiaries become acutely aware of the cost differences between brand-name and generic drugs and most make the switch. Unfortunately, by not using generics in the initial phase of the benefit, they put themselves at greater risk for hitting the Coverage Gap much faster," said Eisenberg.

The cost difference between generics and brand name drugs for patients in the Coverage Gap can be significant. In the initial covered phase of the benefit, the average cost of 30 days of branded therapy of lipid-lowering medications for standard eligible patients is $30.89 versus $7.06 for a generic. In the Coverage Gap, it increases to $88.44 for brands and $16.14 for generics.

Bridging the Communication Gap

According to a 2008 Medco survey of 400 Medicare beneficiaries, 78 percent of respondents said they felt that it was important for their health plan to communicate money-saving tips to help delay reaching the Gap. In addition, a majority of respondents indicated that programs alerting them to their proximity to the Gap were significant factors in their decision to re-enroll with the plan.

Recognizing the importance of educating enrollees about the Coverage Gap, Medco has introduced a Coverage Gap communications program that alerts its Prescription Drug Plan members and specific health plan beneficiaries through mailings and outbound phone calls of their proximity to the Gap long before they reach it. Additionally, any time one of these members contacts a customer service representative for any reason, a Coverage Gap status update is provided. To increase the likelihood that physicians will prescribe a generic drug rather than a brand, Medco offers members prescription forms they can bring to their physician or contacts the doctor on the member's behalf to discuss generic alternatives that can lower the member's costs.

Medco's specialist pharmacists, who are dedicated to the treatment of patients with specific chronic and complex diseases such as diabetes and heart disease, counsel members on the importance of compliance and utilize integrated data systems to identify patients who are not properly adhering to their medication regimens.

About Medco

Medco Health Solutions, Inc. (NYSE: MHS) is the nation's leading pharmacy benefit manager based on its 2007 total net revenues of more than $44 billion. Medco's prescription drug benefit programs, covering approximately one-in-five Americans, are designed to drive down the cost of pharmacy health care for private and public employers, health plans, labor unions and government agencies of all sizes, for individuals served by the Medicare Part D Prescription Drug Program, and those served by Medco's specialty pharmacy segment, Accredo Health Group. Medco, the world's most advanced pharmacy(R), is positioned to serve the unique needs of patients with chronic and complex conditions through its Medco Therapeutic Resource Centers(R), including its enhanced diabetes pharmacy care practice through the Liberty acquisition. Medco is the highest-ranked independent pharmacy benefit manager on the 2008 Fortune 100 list. On the Net: medcohealth.

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the risks and uncertainties that affect our business, particularly those mentioned in the Risk Factors section of the Company's Annual Report on Form 10-K and Quarterly Reports on Form 10-Q filed with the Securities and Exchange Commission.

Medco Health Solutions, Inc.