Nursing home residents and enrollment in Medicare Part D.
OBJECTIVE
To assess the impact of Medicare Part D in the nursing home (NH) setting.


METHODS
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.


METHODS
Nursing Homes.


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


METHODS
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).


CONCLUSIONS
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.
Briesacher
Becky A
BA
Meyers Primary Care Institute, Worcester, Massachusetts, USA. Becky.briesacher@umassmed.edu
Soumerai
Stephen B
SB
Field
Terry S
TS
Fouayzi
Hassan
H
Gurwitz
Jerry H
JH
D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D009735:Nursing Homes; D014481:United States
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