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News and Notes   |    
News Briefs
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.10.1227
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Kaiser analysis of impact of Part D "doughnut hole": An analysis from the Kaiser Foundation has quantified for the first time the number of Medicare Part D plan enrollees in 2007 who reached a gap in their medication coverage known as the "doughnut hole," when they must pay full prescription costs. Claims data for about 50% of all U.S. retail prescriptions were analyzed, with a focus on Part D enrollees taking drugs in eight classes to treat chronic conditions: Alzheimer's disease, high cholesterol, depression, diabetes, gastroesophageal reflux disease, heart failure, hypertension, and osteoporosis. The analysis found that one in four (26%) Part D enrollees who filled any prescriptions in 2007 reached the coverage gap; only 15% of those reaching the gap had sufficient additional drug spending to receive catastrophic coverage, at which point the plan pays 95% of drug costs. Among all Part D enrollees, 18% filled prescriptions for antidepressants, and 35% of this group reached the gap; 10% later qualified for catastrophic coverage. Antidepressants ranked fourth—behind Alzheimer's treatments, oral antidiabetic drugs, and proton pump inhibitors—in terms of the percentage of users who reached the coverage gap. Of those taking antidepressants who reached the gap, 15% stopped taking the medication, 1% reduced medication use, and 6% switched medications. Among enrollees who reached the gap but not catastrophic coverage, average out-of-pocket spending increased from $104 per month before the gap to $196 per month during the gap. The 37-page report, The Medicare Part D Coverage Gap: Costs and Consequences in 2007, is available on the Kaiser Web site at www.kff.org/medicare.

Web site supports employment of war veterans: A recent RAND report estimates that 300,000 veterans of the wars in Iraq and Afghanistan have returned home with mental health problems and about the same number have experienced head injuries. The U.S. Department of Labor has developed an online resource to help employers recruit and employ veterans with traumatic brain injury and posttraumatic stress disorder (PTSD). The America's Heroes at Work Web site provides information about these conditions as well as tools and guidance on how to implement workplace accommodations and other supports, such as job coaching and mentoring programs. An array of materials is available, including fact sheets and FAQs, curricula, archived Webcasts, and PowerPoint presentations. The success stories of five veterans and four employers are presented, and more stories will be posted as the initiative grows. The Web site also includes the toll-free number (800-526-7234) of the Job Accommodation Network, which provides personal assistance to employers. America's Heroes at Work (www.americasheroesatwork.gov) is managed jointly by the Department of Labor's Office of Disability Employment Policy and Veterans' Employment and Training Service, in collaboration with other federal agencies engaged in programs addressing traumatic brain injury and PTSD, including the Department of Defense, the Department of Veterans Affairs, the Department of Health and Human Services, the Department of Education, and the Social Security Administration.

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