Download “Mental Health Patients Face High Out-of

“Mental Health Patients Face High Out-of-Pocket
Costs Under Medicare Part D Prescription Benefit;
Most Mental Health Patients Subject to 'Doughnut
Hole',” Thomson Medstat, Press Release, 6/5/06
Study Presented at ISPOR 11th Annual Meeting Analyzes Implications of Drug Benefit for
Beneficiaries with Mental Illness
ANN ARBOR, Mich., June 5 /PRNewswire/ -- Elderly Americans with mental illness who opt into
the Medicare Part D prescription drug benefit will spend up to four times more in out-of-pocket
expenses than their privately insured counterparts. They will reach the plan's "doughnut hole" the gap in coverage between $2,251 and $5,100 in drug payments - up to two months earlier than
the average for all Medicare patients, according to a new study from Thomson Medstat, a
business of The Thomson Corporation (NYSE: TOC; TSX: TOC).
The study, presented at the recent International Society for Pharmacoeconomics & Outcomes
Research 11th Annual International Meeting, estimates the out-of-pocket costs of Medicare
beneficiaries with depression, anxiety disorders and schizophrenia, using the actual claims
experience of Medicare beneficiaries who are in employer-sponsored retiree plans. It also
investigates the timing of the doughnut hole and examines the effects of price increases on drug
utilization.
The researchers analyzed the Medstat MarketScan(R) databases for 1,114,009 Medicare recipients
with employer-sponsored Medicare supplemental coverage for calendar year 2004 and found that
out-of-pocket costs for all prescription medications would be higher for mental health patients
than other Medicare beneficiaries. Specifically, patients with:
* Schizophrenia - would spend $2,453 in one calendar year under Medicare Part D, compared
with $596 for patients with employer-sponsored plans; a difference of 76 percent.
* Depression - would spend $2,181 in one calendar year under Medicare Part D, compared with
$694 for patients with employer-sponsored plans; a difference of 68 percent.
* Anxiety - would spend $1,884 in one calendar year under Medicare Part D, compared with $659
for patients with employer-sponsored plans; a difference of 65 percent.
A major reason for the overall higher drug costs for patients with mental illness is that their
mental health problems may complicate other, physical health problems, and vice versa requiring more medication as a result.
This phenomenon helps to drive the rapid pace at which mental health patients reach the
doughnut hole in the Medicare prescription drug benefit. Half of the Medicare patients in the
study would have reached the doughnut hole by August 6 of the study year, leaving them fourand-a-half months in the year during which they would have to pay additional costs out-ofpocket. Mental health patients will reach the milestone faster. Specifically, half of patients with:
* Schizophrenia - would reach the doughnut hole by June 1.
* Depression - would reach the doughnut hole by June 21.
* Anxiety - would reach the doughnut hole by July 6.
The study also analyzed the impact of out-of-pocket cost increases on prescription drug
utilization, based upon the theory that patients will reduce consumption of maintenance
medications by as much as 0.1 percent to 0.4 percent for every 1 percent increase in co-payments.
Since patients must pay the entire cost of their medications once they reach the doughnut hole,
these changes in utilization have major impacts on expenditures.
The study's lead author is Teresa B. Gibson, PhD, a director of research at Thomson Medstat. The
research was conducted under a contract between Thomson Medstat and The National Institute
of Mental Health in Bethesda, Maryland.
"The new Medicare drug law protects elderly patients with mental illness who would otherwise
have had no coverage and face high prescription drug costs, but existing private coverage is
substantially better than the standard Part D plan," said Gibson. "Employers play an important
role in providing prescription drug coverage to retirees. Employers weighing a move to Medicare
Part D for retiree benefits need to consider more than the initial cost savings, especially when the
impacts from potentially decreased utilization are taken into account."
About Thomson Medstat
Thomson Medstat (http://www.medstat.com/) solutions - including business intelligence and
benchmark databases, decision support solutions, and research services - help employers,
government agencies, health plans, hospitals, and pharmaceutical companies manage the cost
and quality of healthcare.
About The Thomson Corporation
The Thomson Corporation (http://www.thomson.com/), with 2005 revenues of approximately
$8.5 billion, is a global leader in providing integrated information solutions to business and
professional customers. Thomson provides value-added information, software tools and
applications to more than 20 million users in the fields of law, tax, accounting, financial services,
higher education, reference information, corporate e-learning and assessment, scientific research
and healthcare. With operational headquarters in Stamford, Conn., Thomson has approximately
40,500 employees and provides services in approximately 130 countries. The Corporation's
common shares are listed on the New York and Toronto stock exchanges (NYSE: TOC; TSX:
TOC).
Source: Thomson Medstat
CONTACT: John Roderick for Thomson Medstat, +1-631-584-5808, or
[email protected]; or David Wilkins of Thomson Medstat, +1-734-913-3397, or
[email protected]
Web site: http://www.medstat.com/