Nursing Home Residents Having Serious Problems Getting Proper Drugs

Nursing home residents are experiencing serious problems receiving the correct medications since implementation of Medicare Part D, according to an analysis by the Long Term Care Pharmacy Alliance (LTCPA), an association of pharmacies that dispense drugs to nursing homes and other long-term care facilities. The situation would be improved considerably if the Bush administration lifted its current ban on allowing caregivers of nursing home residents to help them choose a plan, the LTCPA says.

Most nursing home residents are on Medicaid and were receiving prescription drug coverage through that program before the new Medicare drug benefit took effect on January 1, 2006. On that date, nursing home residents eligible for both Medicaid and Medicare lost their Medicaid drug coverage and were switched to one of the private drug plans under the new Medicare drug program, Part D.

Because of their poor physical and mental condition, most nursing home residents did not choose their own Medicare drug plan but were randomly assigned to one by the Centers for Medicare and Medicaid Services (CMS). Because the auto-enrollment process did not attempt to match beneficiaries with the plans that best covered their medications, many were assigned to plans that do not cover all of their drugs or impose particularly burdensome requirements such as filing for exceptions and appeals, the LTCPA says.

As a result, physicians who care for frail elderly patients in long-term care settings are running into significant problems in obtaining appropriate medications for their patients. In a June 2006 survey, the American Medical Directors Association found that 70 percent of long-term care facility doctors said that they are "frequently" or "very frequently" having trouble obtaining the proper drugs for their patients.

"It has put severe financial and administrative strain on physicians, nursing homes, [long-term care] pharmacists and [prescription drug plans] who have stepped in and assumed the burden of working through the difficult administrative procedures required to get drug coverage approved," the LTCPA says in a new policy analysis.

ElderLawAnswers warned of this outcome in a May 2005 investigative article (see "Switch to Medicare Drug Coverage Poses Dire Risk for Nursing Home Residents, Experts Warn").

The biggest obstacle to matching nursing home residents with the best Medicare drug plans, the LTCPA says, is the current CMS rule that prohibits those most familiar with nursing home residents' drug usage '“ their caregivers '“ from assisting the residents in choosing and enrolling in a plan that best matches their needs.

The LTCPA is calling on CMS to allow caregivers to help nursing home residents in selecting and enrolling in Part D plans.

"Part D was primarily designed with the non-institutional senior population in mind," the LTCPA says. "For the most part, it does not take into consideration the frail mental and physical condition which limits nursing home beneficiaries' capacity to 'shop' for a Part D plan."

For the LTCPA policy analysis, "The Need to Change CMS Rules to Allow Caregivers to Help Nursing Home Residents Choose a Part D Plan," click here.

For a press release on the American Medical Directors survey of long-term care facility physicians, click here.

For a UPI article on a congressional briefing on the problem by long-term care industry leaders, click here.