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Nursing Home Residents and Enrollment in Medicare Part D
Author(s) -
Briesacher Becky A.,
Soumerai Stephen B.,
Field Terry S.,
Fouayzi Hassan,
Gurwitz Jerry H.
Publication year - 2009
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2009.02454.x
Subject(s) - medicine , nursing homes , nursing , family medicine , medline , gerontology , political science , law
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.