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. 2009 Oct;57(10):1902-7.
doi: 10.1111/j.1532-5415.2009.02454.x. Epub 2009 Aug 21.

Nursing home residents and enrollment in Medicare Part D

Becky A Briesacher  1 , Stephen B Soumerai, Terry S Field, Hassan Fouayzi, Jerry H Gurwitz
Affiliations

Nursing home residents and enrollment in Medicare Part D

Becky A Briesacher et al. J Am Geriatr Soc. 2009 Oct.

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.

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Conflict of interest statement

Conflict of Interest. None of the authors of this manuscript have conflicts of interest to declare.

Figures

Figure 1
Figure 1
Sources of Drug Payments for NH Residents, 2005–2006.
Figure 2
Figure 2
Changes in Share of Total Drug Costs Paid Out-of-Pocket by NH Residents.
Figure 3
Figure 3
Changes in Prescription Use by NHs by Part D enrollment.
See this image and copyright information in PMC

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