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Medicare Drug Law Could Create Havoc in Nursing Homes

  • December 6th, 2004

Long-term care experts are expressing grave concern that the new Medicare prescription drug program will be unworkable for most of the 1.5 million Americans who live in nursing homes, according to an article in The New York Times.

Most nursing home residents are on Medicaid and currently receive coverage of their prescription drugs through that program. Drugs are supplied to nursing homes by specialized long-term-care pharmacies.

The new Medicare law would do away with all this. Medicaid coverage of prescription drugs for the elderly is scheduled to end on January 1, 2006, when Medicare drug benefit becomes available. The Medicare benefit will be administered by competing private companies, each of which will offer its own list of approved drugs, known as a formulary, and its own network of retail pharmacies.

The idea behind the new law is that Medicare beneficiaries will carefully compare these competing drug plans and enroll in the ones that best meet their needs. But more than one-third of nursing home residents have Alzheimer's disease or another form of dementia, and many more are in no condition to compare drug plans.

Moreover, the new companies that will deliver the drug benefit have little if any experience serving the special needs of nursing home residents, many of whom receive medications through feeding tubes. So far, there is no role for the long-term-care pharmacies that currently serve nursing homes.

"The way it's supposed to work under the new law is totally confusing," said Joan E. DaVanzo, vice president of the Lewin Group, a health care consulting group that recently received a federal contract to study pharmacy services in nursing homes. "The mandates of the law run contrary to the practice of the industry. The law presumes that Medicare beneficiaries are sophisticated elderly people living in the community and using retail drugstores."

In addition, the Medicare formularies will undoubtedly be more restrictive than what is currently available under Medicaid. This could mean that doctors will need to write new prescriptions for hundreds of thousands of nursing home residents, switching them from the drugs they now take to those approved by Medicare.

"If nursing homes have to deal with multiple formularies from multiple prescription drug plans, that will result in chaos and an increased potential for medication errors," said Thomas R. Clark, policy director for the American Society of Consultant Pharmacists, whose 7,000 members specialize in drug care for the elderly.

"We don't have a clue how the system is supposed to work under the new law," said Laurence F. Lane, vice president of Genesis HealthCare, which operates 192 nursing homes in 12 states. "We don't know what will happen on January 1, 2006."

To read the full article in The New York Times, click here. (Free registration required and article may no longer be available free of charge.)

For a shorter version of the Times article in the Indianapolis Star, go to: www.indystar.com/articles/7/199951-4267-052.html

For the response of the Centers for Medicare and Medicare Services to the article, click here.

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Last Modified: 12/06/2004

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