Nursing Home Residents and Enrollment in Medicare Part D.

Becky A. Briesacher, University of Massachusetts Medical School
Stephen B. Soumerai, Harvard Medical School
Terry S. Field, University of Massachusetts Medical School
Hassan Fouayzi, University of Massachusetts Medical School
Jerry H. Gurwitz, University of Massachusetts Medical School

Abstract

OBJECTIVES: To assess the impact of Medicare Part D in the nursing home (NH) setting.

DESIGN: A population-based study using 2005/06 prescription dispensing records, Poisson regressions with generalized estimating equations, and interrupted times series estimation with segmented regression methods.

SETTING: Nursing Homes.

PARTICIPANTS: A nationwide sample of long-stay Medicare enrollees in NHs (N=861,082).

MEASUREMENTS: Probability of Part D enrollment, changes in source of drug payments, changes in average number of monthly prescriptions dispensed per resident.

RESULTS: In 2006, 81.0% of NH residents were enrolled in Part D, 16.1% had other drug coverage, and 3.0% (n=11,000) remained without drug coverage, which was the same rate of no drug coverage as in 2005. NH residents who did not enroll in Part D were the oldest (relative risk (RR)=0.82, P<.001), had no drug coverage in 2005 (RR=0.84, P<.001), and had high comorbidity burden (RR=0.94, P<.001). The proportion of prescription drugs paid out of pocket decreased from 11.0% in 2005 to 8.1% in 2006 (P<.001). Average monthly prescription use per resident in 2006 decreased by half a prescription from 2005 levels (9.6 vs 10.1, P=.003).

CONCLUSION: Part D decreased some out-of-pocket drug costs but did not expand drug coverage in the NH population or reach some vulnerable segments. Part D was also associated with some disruption in NH drug use, especially right after implementation.