title: Impact of final short-fill rule on Medicare Part D costs and long-term care pharmacy dispensing.
abstract: OBJECTIVE
  To evaluate the impact of the final Centers for Medicare & Medicaid Services' (CMS) "short-fill" rule regarding the appropriate dispensing of prescription drugs in long-term care facilities.
  
  
  METHODS
  A prospective study to determine rates of unconsumed medication and the net-cost impact on Medicare Part D prescription drug plans based on the proposed and final CMS rule and other scenarios under consideration by CMS.
  
  
  METHODS
  Four hundred twenty-five long-term care facilities in six states.
  
  
  METHODS
  Residents covered by Medicare Part D.
  
  
  METHODS
  Rates of unconsumed medication, average dispensing fees, potential reduction in unconsumed medication, incremental fills, incremental dispensing fees, net cost or savings to Medicare Part D plans, and percentage increase in fills.
  
  
  RESULTS
  Total estimates of the cost of unconsumed medication charged to Medicare Part D plans for residents in long-term care facilities are $87 million for brand products and $39 million for generics annually. Based on current dispensing fees, it is likely that implementation of the final rule will result in incremental costs to CMS plans in the range of $30 million annually. The number of Medicare Part D prescription fills will increase by about 20%. A seven-day fill requirement on brand products would raise incremental costs to more than $150 million annually, and inclusion of generic products in a seven-day fill requirement would result in incremental costs in the range of $850 million annually.
  
  
  CONCLUSIONS
  The final CMS rule on short-fills is unlikely to result in savings to Medicare Part D plans. Shorter fill times and inclusion of generic products would significantly raise costs to these plans.
authors.affiliation: Managed Solutions, LLC, Conifer, Colorado 80433, USA. gary@managedsolutionsllc.com
authors.forename: Gary
authors.initials: G
authors.lastname: Bazalo
authors.forename: Richard C
authors.initials: RC
authors.lastname: Weiss
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics; D017046:Cost Savings; D016527:Drug Costs; D016568:Drugs, Generic / Q000191:economics; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D008134:Long-Term Care / Q000191:economics; D054524:Medicare Part D / Q000191:economics* / Q000331:legislation & jurisprudence; D010593:Pharmaceutical Services / Q000191:economics*; D055553:Prescription Drugs / Q000191:economics*; D011446:Prospective Studies; D012051:Reimbursement Mechanisms; D013997:Time Factors; D014481:United States
chemical_list: D016568:Drugs, Generic; D055553:Prescription Drugs