Are Nursing Home Residents Benefiting From Medicare Part D?
Briesacher BA, Soumerai SB, Field TS, Fouayzi H, Gurwitz JH
J Am Geriatr Soc. 2009;57:1902-1907
The Medicare Part D prescription plan was created in part to help patients reduce their out-of-pocket expenses for medications. Long-term nursing home residents were expected to be particularly affected. This study aimed to look at how Medicare Part D affected drug costs, as well as what happened to the various forms of prescription drug coverage this population previously had.
The study included over 800,000 patients who were residing in nursing homes. The data were obtained from a large long-term care pharmacy provider and included residents in 48 states. Patients were excluded if they were not eligible for Medicare coverage or if they had stayed at the facility for less than 4 months. The period of data collection was from January 2005 to December 2006, to capture a year before and after Medicare Part D implementation. Data were collected on all drug dispensing including over-the-counter and as-needed medications in addition to prescription products. The study also identified the number of patients who had the following types of drug coverage before and after Medicare Part D implementation: Medicaid, Medicare Parts A and B, third-party coverage, no drug coverage.
Baseline demographic data showed that of the study participants reviewed, 69% were female, 12.9% were younger than 65, 36.1% were 85 or older, and most lived in the Midwest (36.4%) or South (28.4%). The following changes occurred in payment sources for medications before and after Medicare Part D: Medicaid decreased from 39% to 12%, third party decreased from 17% to 12%, and cash payments (no coverage) decreased from 11.1% to 8%. The costs paid by Medicare A and B remained about the same. Enrollment in Medicare Part D affected 81% of patients.
Patients who enrolled in Part D significantly decreased their percentage of out-of-pocket drug costs from 11.1% to 6.1%. Those who did not enroll had their out-of-pocket costs remain the same, around 23%. The biggest benefit was realized in those with no drug coverage, whose out-of-pocket expenses significantly decreased from 100% to 34%. In the Medicaid and third-party groups, costs decreased from 4% to 2% and 14% to 9%, respectively. Older age, higher comorbidity burden, and having no prescription drug coverage were factors that made it less likely to enroll in Medicare Part D.
This analysis did show that out-of-pocket medication costs decreased with the start of the Medicare Part D program. A particularly concerning piece of information was that individuals who stood to benefit most from the plan (older patients, no drug coverage, higher comorbidities) were the least likely to enroll. Socioeconomic status and education level were not collected, but it would have been interesting to see if these factors were more prevalent in these groups or if these factors independently affected enrollment in the plan.
A previous study looked at differences in interaction with Part D drug plans among nursing home patients in urban vs rural settings. That study found that patients in rural settings interacted more with the plans. The authors suggested that family members in rural settings may be more engaged in helping patients make decisions regarding Medicare Part D.
Both of these studies make one wonder whether patients in nursing homes are being educated about Medicare Part D plans. Many of the information resources are found online, and most patients in nursing homes do not use this technology. Thus, they likely have limited access to information. This demonstrates an ongoing role for pharmacists to aid in helping patients choose appropriate drug coverage plans.
This study did not include data regarding the actual costs of the Medicare Part D plans, so the reported decrease in cost may not have been as large with this factored in. Cost was shifted away from Medicaid, but many patients still needed to use Medicaid for prescriptions that were not covered by Part D plans or for copayments they could not afford.
Medicare Part D represents a step forward in helping patients better afford their medications. However, much more long-term analysis is needed to evaluate the complete impact. Significant out-of-pocket expenses still exist for certain patient populations, and while this study found cost reductions in those with the highest costs, a 5% decrease might not be that significant.
Nursing Home Residents and Enrollment in Medicare Part D
Briesacher BA, Soumerai SB, Field TS, Fouayzi H, Gurwitz JH
J Am Geriatr Soc. 2009;57:1902-1907
Study Summary
The Medicare Part D prescription plan was created in part to help patients reduce their out-of-pocket expenses for medications. Long-term nursing home residents were expected to be particularly affected. This study aimed to look at how Medicare Part D affected drug costs, as well as what happened to the various forms of prescription drug coverage this population previously had.
The study included over 800,000 patients who were residing in nursing homes. The data were obtained from a large long-term care pharmacy provider and included residents in 48 states. Patients were excluded if they were not eligible for Medicare coverage or if they had stayed at the facility for less than 4 months. The period of data collection was from January 2005 to December 2006, to capture a year before and after Medicare Part D implementation. Data were collected on all drug dispensing including over-the-counter and as-needed medications in addition to prescription products. The study also identified the number of patients who had the following types of drug coverage before and after Medicare Part D implementation: Medicaid, Medicare Parts A and B, third-party coverage, no drug coverage.
Baseline demographic data showed that of the study participants reviewed, 69% were female, 12.9% were younger than 65, 36.1% were 85 or older, and most lived in the Midwest (36.4%) or South (28.4%). The following changes occurred in payment sources for medications before and after Medicare Part D: Medicaid decreased from 39% to 12%, third party decreased from 17% to 12%, and cash payments (no coverage) decreased from 11.1% to 8%. The costs paid by Medicare A and B remained about the same. Enrollment in Medicare Part D affected 81% of patients.
Patients who enrolled in Part D significantly decreased their percentage of out-of-pocket drug costs from 11.1% to 6.1%. Those who did not enroll had their out-of-pocket costs remain the same, around 23%. The biggest benefit was realized in those with no drug coverage, whose out-of-pocket expenses significantly decreased from 100% to 34%. In the Medicaid and third-party groups, costs decreased from 4% to 2% and 14% to 9%, respectively. Older age, higher comorbidity burden, and having no prescription drug coverage were factors that made it less likely to enroll in Medicare Part D.
Viewpoint
This analysis did show that out-of-pocket medication costs decreased with the start of the Medicare Part D program. A particularly concerning piece of information was that individuals who stood to benefit most from the plan (older patients, no drug coverage, higher comorbidities) were the least likely to enroll. Socioeconomic status and education level were not collected, but it would have been interesting to see if these factors were more prevalent in these groups or if these factors independently affected enrollment in the plan.
A previous study looked at differences in interaction with Part D drug plans among nursing home patients in urban vs rural settings. That study found that patients in rural settings interacted more with the plans. The authors suggested that family members in rural settings may be more engaged in helping patients make decisions regarding Medicare Part D.
Both of these studies make one wonder whether patients in nursing homes are being educated about Medicare Part D plans. Many of the information resources are found online, and most patients in nursing homes do not use this technology. Thus, they likely have limited access to information. This demonstrates an ongoing role for pharmacists to aid in helping patients choose appropriate drug coverage plans.
This study did not include data regarding the actual costs of the Medicare Part D plans, so the reported decrease in cost may not have been as large with this factored in. Cost was shifted away from Medicaid, but many patients still needed to use Medicaid for prescriptions that were not covered by Part D plans or for copayments they could not afford.
Medicare Part D represents a step forward in helping patients better afford their medications. However, much more long-term analysis is needed to evaluate the complete impact. Significant out-of-pocket expenses still exist for certain patient populations, and while this study found cost reductions in those with the highest costs, a 5% decrease might not be that significant.