Medicare Part D: Clear as a Physician’s Signature?
Medicare Part D: Clear as a physician’s signature? An interview with Thomas R. Clark, RPh, MHS |
For America’s Medicare-eligible seniors, December 31, 2005, will signify more than the rollover of another year. Just after the stroke of midnight, fireworks of a less celebratory nature may be ignited when the Medicare Part D prescription drug benefit becomes effective. As it is currently written, the proposed legislation has neglected to include provisions and medications specifically aimed at serving the nation’s nursing home residents. The final rule of the Medicare Prescription Drug Improvement and Modernization Act, commonly referred to as the Medicare Modernization Act (MMA), was issued in late January of this year. Upon stakeholder review, it was found that many problems remain unaddressed, especially as they affect nursing home residents. Nursing Homes/Long Term Care Management asked Thomas R. Clark, RPh, MHS, director of Policy and Advocacy for the American Society of Consultant Pharmacists (ASCP), to address the questions needing answering to make Medicare Part D a viable program for the institutionalized elderly. As the MMA Part D currently stands, what problems does it present to LTC facilities for medication administration safety and procedures? Another, and perhaps the most important issue, is that of the approved formulary for Part D. As it now stands, the formulary in place is structured for ambulatory beneficiaries, that is, community-dwelling Medicare recipients whose medication needs are well below those of more medically complex nursing home residents. For LTC residents this formulary is like putting a square peg in a round hole. It is inappropriate for this special population, and access to medication might be so restricted that hospitalizations could occur in order for residents to access the necessary medications and drug therapies. In particular, what formulary restrictions will most seriously impact nursing home residents? What recommendations has ASCP offered to CMS to carry to lawmakers and regulators to make Part D responsive to institutionalized elderly? It is also beneficial if an LTC facility nurse or pharmacist can act on behalf of a resident’s physician to seek prior authorization for nonformulary drug requests. This would help to ensure the timeliness of medication delivery. If, as it may turn out, PDPs impose specific formularies on facilities, there must be a simple, straightforward process to access medications outside the formulary. What effect does the law have on dual eligibles? How will LTC residents select an MMA Part D plan? In any case, what can facilities do to prepare for the January 1, 2006, implementation date of Medicare Part D? ASCP is continuing discussions with CMS on implementation of Medicare Part D in long-term care settings. We have talked to the folks on Capitol Hill about the excluded medications, but prospects for legislative changes to the MMA do not look good. Thomas R. Clark, RPh, MHS, is Director of Policy and Advocacy for the American Society of Consultant Pharmacists. For further information, call (703) 739-1316 or e-mail tclark@ascp.com. To send your comments to the editors, e-mail hoban0405@nursinghomesmagazine.com. To order reprints in quantities of 100 or more, call (866) 377-6454. |
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