Online Program

Medicare part d and long-term care: A systematic review of quantitative and qualitative evidence

Tuesday, November 5, 2013

Camilla Pimentel, MPH, Graduate School of Biomedical Sciences, Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA
Kate L. Lapane, PhD, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
Becky A. Briesacher, PhD, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
Background: In 2003, Congress established the Medicare Part D prescription drug benefit to improve access to essential medication among disabled and older Americans. Despite previous evidence of positive impact on the general Medicare population, Part D's overall effects on long-term care (LTC) are unknown. Objective: The purpose of this systematic review was to evaluate the literature regarding Part D's impact on costs to LTC residents and providers; prescription drug coverage and utilization; and clinical and administrative outcomes. Data Sources: Four electronic databases, selected US government and non-profit websites, and bibliographies were searched for studies characterizing Part D in the LTC context. Searches were limited to studies published between January 1, 2006 (Part D implementation date) and January 8, 2013. Results: Eleven quantitative and eight qualitative studies met inclusion criteria. Part D decreased out-of-pocket costs among enrolled nursing home residents and increased costs borne by LTC facilities and pharmacies. Coverage of medication frequently used by older adults was adequate, except for certain drugs and alternate formulations of importance to LTC residents. There was decreased use of medication carrying safety concerns, but overall drug utilization may have been unaffected. Impact on clinical outcomes was uncertain, although there was quantitative evidence of unintended health consequences. Qualitative studies consistently revealed increased administrative burden among providers. Conclusion: The empirical evidence of Part D's impact on LTC is sparse. Although LTC-specific policies continue to evolve, Part D may require further modifications to meet the needs of LTC residents and improve compatibility with LTC drug delivery processes.

Learning Areas:

Public health or related public policy

Learning Objectives:
Discuss the ways in which the Medicare Part D prescription drug benefit may affect beneficiaries residing in long-term care settings. Describe impacts of Medicare Part D on long-term care providers.

Keyword(s): Medicare, Long-Term Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a doctoral student, I am interested in studying Medicare/Medicaid policy and long-term care residents. My mentorship team includes a health services researcher who has previously written on the effects of Medicare Part D on nursing home residents.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.