WASHINGTON – Nursing homes that serve the poor and elderly are losing money because of a confusing drug benefit plan,representatives for the pharmaceutical industry said Monday.
Before a room of congressional staffers,the drug company representatives said that,six months after a new Medicare drug benefit plan began,long-term health care providers are still sorting out the details.
It has been “very trying,” said Erica Danielson,social worker for the Pine Hills Continuing Care Center in Nelsonville,Ohio,about working with the new system.
In January,the program automatically enrolled about 6 million “dual eligible patients,” those qualified for both Medicaid and Medicare,under Medicare's drug program into one of a number of different private insurance plans. Medicaid provides care for poor people,and Medicare pays for care for those over age 65.
Some patients who were supposed to be matched with plans that best suited their prescription needs found that medications covered by Medicaid prior to the new program were no longer covered,said Paul Baldwin,executive director of the Long Term Care Pharmacy Alliance.
The prescription drug plan confused both doctors and patients,who at first were unaware of what drugs the plan covered. Doctors continued to prescribe uncovered medication that pharmacies legally had to fill,he added.
When it became clear the drugs were not covered,the pharmacy passed the cost to the nursing home,Baldwin said.
The prescription drug program is having a “significant” negative impact and becoming more of a problem for long-term health care providers,said Thomas Clark,director of policy and advocacy for the American Society of Consultant Pharmacists.
Patients are also affected,jumping hurdles to get medications. Private insurers have criteria for prescribing medicines,such as administering certain drugs only when others have failed,dispensing limited quantities and requiring prior authorization for others,Clark said.
Kelli Wilson with Kimes Convalescent Center,in Athens,Ohio,said her facility,which treats about 20 dual coverage patients,has not experienced those problems.
The pharmacy that fills the center's patients' prescriptions worked out a deal with providers that medication is always covered for the first 30 days. “We don't have a problem,” she said.
A recent survey by the American Medical Directors Association found that 52 percent of long-term care doctors spend more than four hours a week trying to obtain “necessary medications” for their patients and 13 percent spend more than eight hours a week. The group represents doctors who work with patients needing long-term care
Physicians are “overwhelmed,” and they are leaving long term care facilities,Clark said.