HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Sunday, December 5, 2004

Medicare Drug Benefit Stifles Nursing Home Staff

Robert Pear reports in Sunday's New York Times that "[a] wide range of experts on long-term care express serious concern that the new Medicare law will be unworkable for most of the 1.5 million Americans who live in nursing homes":

Nursing home residents take large numbers of prescription drugs, an average of eight a day. But many have physical disabilities and brain disorders that impair their memory and judgment. So they cannot easily shop around for insurance plans to find the best bargains on their drugs, as other Medicare beneficiaries are supposed to do.

Federal and state officials, pharmacists and nursing home directors said they had no idea how these patients would obtain their medicines under the new program, which begins in January 2006.

"Nobody knows where they're going to get their drugs from," said Stanton G. Ades, senior vice president of NeighborCare, a company in Baltimore that supplies drugs to more than 1,500 nursing homes and assisted living centers in 32 states. The role of such long-term care pharmacies under the new law is unclear.

Confusion reigns on both sides of the pharmaceutical supply relationship:

"We don't have a clue how the system is supposed to work under the new law," said Laurence F. Lane, vice president of Genesis HealthCare, which operates 192 nursing homes in 12 states. "We don't know what will happen on Jan. 1, 2006."

The new Medicare benefit, as envisioned by Congress, will be delivered by insurance companies and pharmacy benefit managers like Medco Health Solutions and Express Scripts, through drug stores like Walgreens and CVS. But the typical retail drugstore or pharmacy benefit manager has little experience with nursing home residents.

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