Medicare part D and the nursing home setting

Area of Science:

• Health Services Research
• Pharmacy Practice
• Geriatric Care

Background:

• Medicare Part D significantly altered prescription drug financing and administration in nursing homes.
• Long-term-care pharmacies (LTCPs) and nursing homes faced operational challenges adapting to these changes.

Purpose of the Study:

• To examine the operational changes in LTCPs and nursing homes due to Medicare Part D.
• To assess the implications of these changes for nursing home residents.

Main Methods:

• A review of existing information sources.
• 31 semistructured telephone interviews with key stakeholders conducted between November 2006 and January 2007.

Main Results:

• Medicare Part D introduced increased variability in formularies and drug management processes.
• Staff experienced increased burden and tension between dispensing speed and drug coverage assurance.
• Stakeholders reported wide variation among Part D plans in meeting resident needs.

Conclusions:

• LTCPs, nursing homes, clinicians, and Part D plans are still gaining experience with the benefit in the nursing home setting.
• Longer-term issues and questions require attention as the Medicare Part D benefit evolves for nursing home residents.