WEDNESDAY, July 22 (HealthDay News) -- The number of older Americans with access to prescription drug coverage has ballooned since Medicare's Part D program was rolled out almost four years ago, a new analysis finds, yet seniors' ability to pay for needed medications remains a concern due to limitations in coverage and rising drug plan costs.

"Based on nearly four years of experience, the Medicare drug benefit has helped seniors by expanding access to prescription drug coverage and lowering out-of-pocket costs, particularly helping those who previously lacked drug coverage," said Tricia Neuman, director of the Medicare Policy Project at the Henry J. Kaiser Family Foundation, who led the analysis. "But Medicare Part D is still a work in progress."

Neuman's review of the program, which assesses access and affordability, appears in the July 23 issue of the New England Journal of Medicine.

David Lipschutz, staff attorney for California Health Advocates, a nonprofit advocacy and education outfit, said the analysis of the program, while thorough, was "a little more positive" than he might have given. "I think when looking at Part D, you clearly have to acknowledge a lot more people have access to prescription drug coverage. But Part D has also had a significant impact, too, and has actually left some people worse off."

He noted that low-income seniors who are "dually eligible" for both Medicare and Medicaid were switched from Medicaid drug coverage to Medicare Part D. In California, that shift resulted in seniors losing a relatively rich array of benefits. In general, the commercial plans in which they were forced to enroll offer more-limited drug formularies, greater cost-sharing and the potential for greater barriers to accessing care because of various utilization review techniques, he explained.

Unlike Medicare's hospital and medical insurance programs, Part D benefits are offered through private insurers and drug plans that contract with the government. Often seniors must choose among dozens of plans in a region.

Enrollment in Part D began in November 2005. By the end of the first enrollment period, about 90 percent of all Medicare beneficiaries had drug coverage, according to the report. That's up from 66 percent in 2004.

Today, 59 percent of Medicare's 45.2 million beneficiaries are enrolled in Part D through a standalone prescription drug plan or a "Medicare Advantage" (HMO) drug plan. Thirty-one percent have retiree drug coverage or some other type of drug coverage. That leaves some 4.5 million without any coverage at all, the researchers report.

"People on Medicare who are still without drug coverage include beneficiaries who are relatively healthy and take few drugs who may not think they need this type of insurance," Neuman explained. Others who lack coverage "would likely benefit from having Part D coverage, but for one reason or another are unaware that they need to sign up to get it or are stymied by the process."

A recent University of Pittsburgh study, also published in the New England Journal of Medicine, found that seniors' spending on drugs increased after enrolling in Part D, while spending on medical costs declined. Researchers said that suggests people are getting better control of their medical conditions.

Neuman's paper highlights several concerns with the program, one being the infamous gap in drug coverage known as the "doughnut hole." Once seniors reach an initial coverage limit, they are responsible for any additional drug costs incurred up to a "catastrophic" limit, at which point coverage kicks in again.

Studies show that seniors who hit the coverage gap start shirking on their medication regimens, posing serious risks for people with chronic conditions, Neuman observed.

And while low-income seniors may qualify for subsidies to help pay the Part D premium and cost-sharing, more than 2 million elderly and disabled people are not getting those subsidies, she found.

Meanwhile, premiums and cost-sharing are on the rise, suggesting that seniors may not be in the best plan for their particular needs. Between 2006 and 2009, the weighted average monthly premium rose 35 percent, with the steepest increases among some of the more popular plans.

Thomas Rice, a professor in the department of health services at the University of California, Los Angeles, School of Public Health, says more needs to be done to help Medicare beneficiaries make better choices.

"People are not choosing the plan that's cheapest for them," said Rice, who noted that many older Americans have difficulty navigating the Medicare Web site to compare benefits and costs. Seniors focus too much on the premium instead of the total cost of coverage, and very few switch plans from year to year. Rice guesses that plan sponsors know this and "try to make sure their premiums look pretty cheap."

Lipschutz's best advice for seniors: Contact your State Health Insurance Assistance Program for help walking though your options. "Do your homework each and every year," he said. "It's not a one-time deal."

More information

Compare Part D plans at Medicare.gov.

MONDAY, July 20 (HealthDay News) -- A treatment already used to bolster the immune systems of people with leukemia and other serious diseases might also help ward off Alzheimer's disease, new research suggests.

Researchers looked at the association between the use of intravenous immunoglobulin (IVIg) and the occurrence of Alzheimer's. "IVIg has been used safely for more than 20 years to treat other diseases but is thought to have an indirect effect on Alzheimer's disease by targeting beta-amyloid, or plaques, in the brain," said Dr. Howard Fillit, a clinical professor of geriatrics and medicine at Mount Sinai Medical Center in New York City and the study's lead author.

To assess the effectiveness of IVIg against Alzheimer's disease, researchers analyzed the medical records of 847 people ages 65 and older who'd had at least one IVIg treatment at some point in their life and 84,700 people of the same age who had never received IVIg.

They found that those who had received IVIg were 42 percent less likely to develop Alzheimer's disease. Put another way, about 2.8 percent of those treated with IVIg developed Alzheimer's disease, compared with 4.8 percent of those not treated.

The study was funded in part by Baxter Bioscience, part of the pharmaceutical company that makes IVIg, and one of the four study authors worked for the company. The findings are published in the July 21 issue of Neurology.

"It's exciting," Fillit said of the results. "The study supports the idea that IVIg could be useful for treating Alzheimer's disease. We desperately need disease-modifying treatments for Alzheimer's."

A progressive, neurodegenerative disorder, Alzheimer's afflicts 2.4 to 4.5 million people in the United States, mostly those older than 65, according to the U.S. National Institute on Aging. The disease is marked by a buildup in the brain of plaques made up of beta-amyloid proteins. The plaque is believed to be toxic to the brain, causing cell death over time and a progressive loss of cognitive function, Fillit said.

IVIg, which contains antibodies derived from purified human plasma, is used to treat certain immune deficiencies, autoimmune diseases and cancers.

Though researchers aren't sure of the precise mechanism, it's possible that older people lack sufficient antibodies to beta-amyloid proteins, causing the plaque to accumulate. Fillet said that IVIg might help by giving the immune system a boost and slowing down, or preventing, the buildup of the toxic plaque.

Several drug companies are also at work developing monoclonal antibodies, or artificially produced drugs, to prevent the beta-amyloid buildup.

Despite the study's promising results, the researchers said, they're not suggesting that IVIg be given as a treatment for Alzheimer's yet. A phase 3 clinical trial testing IVIg as an Alzheimer's treatment is under way, also sponsored by Baxter.

Participants in the trial are getting infusions of IVIg or a placebo every two weeks for 70 weeks, according to the U.S. National Institute of Health's online registry of clinical trials, www.clinicaltrials.gov.

The trial, which will include an estimated 360 participants, is expected to be completed in July 2011.

If the clinical trial shows that IVIg is beneficial, it could be a potent new weapon against Alzheimer's, treating the underlying cause of the disease rather than just the symptoms, Fillit said.

"I don't think we would recommend doctors do it right now, but if the clinical study works, then there's potential that doctors could start using it as soon as the results are known," he said.

Dr. Victor Henderson, a professor of epidemiology and neurology at Stanford University in California, said he agrees with the need for a clinical trial to effectively assess the value of IVIg.

Among people whose records were examined as part of the study reported in Neurology, he noted, those who had received IVIg had other serious illnesses, which might have meant doctors were less likely to burden them further with a diagnosis of Alzheimer's, Henderson said.

He said it's also possible that early signs of Alzheimer's, such as confusion or forgetfulness, were attributed to other drugs they'd taken or the rigors of coping with the other disease, a factor researchers also noted in the study.

"It's a study with results that deserve follow-up confirmation, and the best way to do that is through a properly designed clinical trial," Henderson said. "The findings do make sense as far as our understanding of the basic underlying biology of the disease."

More information

The U.S. National Institute on Aging has more on Alzheimer's disease.

TUESDAY, June 23 (HealthDay News) -- If you eat a healthy diet, you're likely to live longer.

It might be trite advice, but a new study offers proof that it can make a difference in your longevity.

Those with the best diets reduced their risk of death by up to 25 percent over a 10-year follow-up, said study author Ashima Kant, a professor of nutrition at Queens College of the City University of New York.

Kant and her colleagues extracted information from a National Institutes of Health/AARP database including more than 350,000 men and women, evaluating the link between dietary habits and their risk of death during the follow-up period. They divided the participants into five groups, depending on how closely they followed the 2005 USDA Dietary Guidelines for Americans.

"If you had the highest fifth of these scores, your risk of dying over the follow-up period was 20 to 25 percent lower," Kant said. She found gender differences, with women eating the healthiest reducing their risk of death by 25 percent and men reducing it by 20 percent.

"We have been advocating these kinds of behaviors for a while," she said. Other studies have found a survival benefit but have tended to look only at individual foods, she said. "This gets at looking at all these dietary features in a collective way," she said.

Kant's team asked the participants about six components of a healthy diet, including intake of fruits, vegetables, low-fat dairy, whole grains, lean meat and poultry, and fat.

People didn't have to eat perfectly to get a top score, she said. For instance, "if a person had five or six servings of vegetables a week, that would get them the top score [for that question]," she said.

"It's not that you have to do everything [recommended under the dietary guidelines] to have any health benefits," she said, noting that participants in the groups with lower (but not the lowest) scores also tended to live longer. For instance, women who were in the second-from-the-highest group on dietary scores were 20 percent less likely to die and men in that group were 17 percent less likely.

The study is published in the July issue of The Journal of Nutrition.

Good dietary habits may also help delay the progression of hardening of the arteries, according to a separate study published in the July issue of the The American Journal of Clinical Nutrition. Researchers from Tufts University and Wake Forest University evaluated the effect of a good diet on the progression of coronary artery disease in 224 postmenopausal women who had the disease when they enrolled in the Estrogen Replacement and Atherosclerosis Study. The better the diet, the slower the progression of disease, they found.

"Both studies are finding similar things," said Penny Kris-Etherton, a distinguished professor of nutrition at Penn State University, who wrote an editorial to accompany the atherosclerosis study.

"We're getting more and more evidence that diet [when poor] can play a key role in chronic disease development, progression and all-cause mortality," she said.

Will the findings -- especially the fact that those who got the top benefit didn't eat perfectly -- inspire people?

"As a nutritionist, you try to be optimistic and hope so," Kris-Etherton said. "But society sometimes makes it difficult. We live in an environment where there are so many food choices that aren't consistent with our [dietary] guidelines."

More information

To learn more about the dietary guidelines, visit the U.S. Department of Health and Human Services.