OBJECTIVES: To assess the impact of Medicare Part D in the nursing home (NH) setting. DESIGN: 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. SETTING: Nursing Homes. PARTICIPANTS: A nationwide sample of long-stay Medicare enrollees in NHs (N=861,082). MEASUREMENTS: 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). CONCLUSION: 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.
OBJECTIVES: To assess the impact of Medicare Part D in the nursing home (NH) setting. DESIGN: 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. SETTING: Nursing Homes. PARTICIPANTS: A nationwide sample of long-stay Medicare enrollees in NHs (N=861,082). MEASUREMENTS: 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). CONCLUSION: 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.
Authors: Haiden A Huskamp; David G Stevenson; Nancy L Keating; Joseph P Newhouse Journal: Health Aff (Millwood) Date: 2008 Mar-Apr Impact factor: 6.301
Authors: Patricia Neuman; Michelle Kitchman Strollo; Stuart Guterman; William H Rogers; Angela Li; Angie Mae C Rodday; Dana Gelb Safran Journal: Health Aff (Millwood) Date: 2007-08-21 Impact factor: 6.301
Authors: Wesley Yin; Anirban Basu; James X Zhang; Atonu Rabbani; David O Meltzer; G Caleb Alexander Journal: Ann Intern Med Date: 2008-01-07 Impact factor: 25.391
Authors: Haiden A Huskamp; David G Stevenson; A James O'Malley; Stacie B Dusetzina; Susan L Mitchell; Barbara J Zarowitz; Michael E Chernew; Joseph P Newhouse Journal: Med Care Date: 2013-10 Impact factor: 2.983
Authors: Andrew R Zullo; Tingting Zhang; Yoojin Lee; Kevin W McConeghy; Lori A Daiello; Douglas P Kiel; Vincent Mor; Sarah D Berry Journal: J Am Geriatr Soc Date: 2018-12-21 Impact factor: 5.562
Authors: Andrew R Zullo; David D Dore; Lori Daiello; Rosa R Baier; Roee Gutman; David R Gifford; Robert J Smith Journal: J Am Med Dir Assoc Date: 2016-03-24 Impact factor: 4.669
Authors: Kathryn Sine; Yoojin Lee; Andrew R Zullo; Lori A Daiello; Tingting Zhang; Sarah D Berry Journal: J Am Geriatr Soc Date: 2019-02-27 Impact factor: 5.562
Authors: Brianne Olivieri-Mui; Jean McGuire; Sean Cahill; John Griffith; Becky Briesacher Journal: J Assoc Nurses AIDS Care Date: 2019 Jan-Feb Impact factor: 1.354
Authors: Michael A Steinman; Andrew R Zullo; Yoojin Lee; Lori A Daiello; W John Boscardin; David D Dore; Siqi Gan; Kathy Fung; Sei J Lee; Kiya D R Komaiko; Vincent Mor Journal: JAMA Intern Med Date: 2017-02-01 Impact factor: 21.873