Coverage and use of prescription drugs in nursing homes: implications for the medicare modernization act

The Medicare Modernization Act will affect drug coverage for most nursing home residents in the United States. Understanding the impact of the MMA requires knowledge of the process by which drugs are prescribed to residents and the effect of coverage on medication use.

We sought to characterize sources of drug coverage for Medicare beneficiaries residing in nursing facilities and to provide empirical estimates of the relationship between coverage and use.

We used bivariate and multivariate analyses to assess the relationship between coverage and drug use in a sample of nursing home residents drawn from the 2001 Medicare Current Beneficiary Survey augmented with monthly institutional drug administration data.

A total of 789 residents with a mean nursing home stay of 8.7 months in 2001 were studied.

We measured the proportions of residents with drug coverage from Medicaid, other sources, or none at all, and mean number of unique prescription drugs administered per resident per month by source of coverage.

We found that 20% of the sample had no drug coverage, 56% had drug coverage under Medicaid, 9% had coverage from other sources, and for 15% drug coverage status could not be determined. There were no statistically significant differences in drug utilization by drug coverage status.

When drug coverage becomes a Medicare benefit in 2006, it is unlikely to spur additional medication use among nursing home residents but may redirect utilization as a result of health plan formulary restrictions.