Performance Improvement 2009. Do Nursing Homes Make Medicare Prescription Drugs Available to Their Medicare-Medicaid Dual Eligible Residents?


This study provided an assessment of the availability of Medicare Part D prescription drugs to dual-eligible nursing home residents. It focused on issues that arose in the early stages of implementing the new benefit. The study was based on structured interviews with a sample of nursing home administrators, medical directors, and directors of operations for long term care pharmacies.

Dual-eligible nursing home residents receive all necessary drugs covered by Part D plans. However, nursing homes and long term care pharmacies sometimes pay for drugs not covered by Part D plans. Administrators and pharmacy directors explained that the drugs they most commonly paid for either were not on the residents’ plans’ formularies or required prior authorization. In addition, respondents expressed concerns that formularies, the prior authorization process, and copayments might pose problems for dual-eligible nursing home residents. Concerns existed that long term care pharmacies generally did not disclose to physicians the rebates that they receive from drug manufacturers. The agency will work with plans to ensure that formularies meet the needs of dual-eligible nursing home residents and continue to work with plans to improve the prior authorization process; ensure that copayments for dual-eligible nursing home residents are fully subsidized, as appropriate; and consider methods to encourage long term care pharmacies to disclose to physicians information about rebates that they receive from drug manufacturers.

Report Title: Availability of Medicare Part D Drugs to Dual-Eligible Nursing Home Residents
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General
PIC ID: 8980

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