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

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.