Medicare Beneficiaries, Especially Unsubsidized Minorities, Struggle to Pay for Prescription Drugs: Results from the Medicare Current Beneficiary Survey

  • Meng LiEmail author
  • Mark Bounthavong
Concise Research Report


In 2006, Medicare started offering outpatient prescription drug benefit—Part D—with significant cost sharing, including a coverage gap (“donut hole”) that required patients to pay the full cost of drugs while in the gap and up to 5% cost sharing after patients reach the catastrophic coverage limit (> $5100 in 2019). Nearly 1 in 10 Part D enrollees had drug spending above the catastrophic coverage threshold in 2015, a quarter of whom did not receive low-income subsidies (LIS) and encountered an average out-of-pocket spending of $3041 annually.1 High cost sharing can lead to cost-coping behaviors such as delaying medication refills, switching to lower-cost alternatives, and spending less on other necessities. Two previous studies on a regional Medicare Advantage (MA) population shortly after Part D went into effect in 2006 found that 26–36% reported at least one cost-coping behavior.2, 3Cost sharing in Part D can create greater financial barriers for minorities and lead to...


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Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Cubanski J, Neuman T, Orgera K, Damico A. No limit: Medicare Part D enrollees exposed to high out-of-pocket drug costs witout a hard cap on spending. Kaiser Family Foundation Issue Brief. 2017.Google Scholar
  2. 2.
    Hsu J, Fung V, Price M, Brand R, Hui R, Fireman B, et al. Medicare Beneficiaries ’ Knowledge of Part D and Responses to Drug Costs. JAMA. 2008;299(16):1929–36.CrossRefPubMedGoogle Scholar
  3. 3.
    Fung V, Reed M, Price M, Brand R, Dow WH, Newhouse JP, et al. Responses to medicare drug costs among near-poor versus subsidized beneficiaries. Health Serv Res. 2013;48(5):1653–68.PubMedPubMedCentralGoogle Scholar
  4. 4. Medicare Current Beneficiary Survey (MCBS) [Internet]. [cited 2019 Jun 7]. Available from:

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Leonard D. Schaeffer Center for Health Policy & Economics University of Southern CaliforniaLos AngelesUSA
  2. 2.Sol Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.VA Health Economics Resource CenterMenlo ParkUSA
  4. 4.School of Medicine, Stanford UniversityPalo AltoUSA

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