HHS OIG report discusses Medicare Pard D and dual eligibles
US DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE OF THE INSPECTOR
GENERAL REPORTS:
“Availability of Medicare Part D Drugs to Dual-Eligible Nursing Home
Residents” (OEI-02-06-00190, June 2008, .pdf format, 28p.).
Abstract:
This final report provides an assessment of the availability of Medicare
Part D drugs to dual-eligible nursing home residents. Our review focused
on ongoing implementation issues as opposed to the issues related to the
transition from Medicaid to Medicare that arose in the early stages of the
benefit. The study is based on structured interviews with a sample of
nursing home administrators, medical directors, and directors of
operations for long-term care pharmacies.
According to most respondents, dual-eligible nursing home residents are
receiving all necessary Part D drugs. However, nursing homes and
long-term care pharmacies sometimes pay for Part D drugs that are not
covered by plans. Administrators and pharmacy directors explained that
the drugs they most commonly pay for either are not on the residents plans
formularies or require prior authorization. In addition, respondents
express concerns that formularies, the prior authorization process, and
copayments may pose problems for dual-eligible nursing home residents.
Concerns also exist that long-term care pharmacies generally do not
disclose to physicians the rebates that they receive from drug
manufacturers.
We recommended that CMS work with plans to ensure that formularies meet
the needs of dual-eligible nursing home residents; continue to work with
plans to improve the prior authorization process; ensure that copayments
for dual-eligible nursing home residents are fully subsidized, as
appropriate; and consider methods to encourage long-term care pharmacies
to disclose to physicians information about rebates that they receive from
drug manufacturers. CMS concurred with our first two recommendations and
the intent of our third recommendation; it did not concur with our last
recommendation.
Get it here: http://www.oig.hhs.gov/oei/reports/oei-02-06-00190.pdf