In case you missed it, CBS News had a story last night on the problems doctors are having getting prescriptions approved for nursing home residents enrolled in Part D.
Missouri Dr. Jeff Kerr, who is profiled in the story, cares for 300 nursing home residents. He is having to spend almost half an hour on the phone with some PDPs in order to get a single drug approved for just one of his patients. In addition to the administrative problems, in some cases plans are instructing the doctor to prescribe drugs the doctor believes will harm the patient. In some cases, this has resulted in the more costly expense of sending patients to the hospital because they have not received the proper medication. The doctor in the story supports Part D, but believes the drug utilization tools and approval procedures used by some PDPs are not appropriate for frail nursing home residents. The doctor in the story states that these problems are common for 100% of the Part D nursing home residents he cares for. LTCPA believes Dr. Kerr’s experience is representative of most of the health care professionals who care for the nation’s 1.6 million nursing home residents.
The story suggests that there should be plans and formularies tailored to meet the unique needs of long-term care residents. The LTCPA strongly agrees with that.
We also believe substantial improvement could be made by modifying the marketing guidelines issued by CMS. As you know, most nursing home residents are dual-eligible, and because of the high levels of cognitive impairment and health problems in the nursing home population, very few nursing home Part D enrollees actually selected their own plans. Most were randomly assigned a plan by CMS, meaning they were not assigned to a plan based on the best match between the drugs they use and the drugs covered by the plan. As duals, they have the right to switch plans every month. However, given their mental and physical health challenges, many do not have the ability to do that on their own and need assistance. Unfortunately, the CMS issued marketing guidelines forbid doctors, nurses and pharmacists in the long-term care setting from recommending a plan to the nursing home residents they care for. If they were allowed to do that, many nursing home Part D enrollees could receive advice and assistance in enrolling in a plan that better matches their drug coverage needs.
Last week, Congressmen English, Waxman and others sent a bipartisan letter to Administrator McClellan urging the marketing guidelines be changed. As CMS is currently revising its marketing guidelines for 2007, we hope other Members of the House and Senate will join them in urging CMS to change these rules as well.
To view the CBS News story, go to:
To view an additional five minute interview with Dr. Kerr
on his experience with Part D, go to:
A copy of congressional letters on changing the marketing guidelines, as well as studies related to the enrollment and formulary issues facing nursing home residents is available at the LTCPA website at ltcpa.org
Thank you for your interest and consideration. LTCPA would happy to answer any questions on this issue, or provide you with additional information.
Director of Government Affairs
Long Term Care Pharmacy Alliance