Ed Schoonveld, a principal at the consultancy ZS Associates, said he was shocked by the drop in consumption and increase in mortality.
“This is certainly one reason we need to seriously consider the impact of copays,” he said.
The researchers focused on beneficiaries who fell into the Medicare Part D coverage gap known as the “donut hole,” where patients are responsible for the full cost of their drugs between certain spending thresholds. Legislative changes have incrementally narrowed that gap, which fully closed in 2020.
In an example in the working paper, a Medicare beneficiary paid 25% of the price of their branded drugs until they reached $2,510 in total annual out-of-pocket spending. The patient fell into the donut hole and had to pay for the full cost until they hit $5,726, after which they were responsible for a 5% copay.
Obermeyer was struck by the finding that the highest-risk patients