Medicare drug benefit requiring close monitoring of chronically ill, dual eligibles

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While providers may be aware the new Medicare prescription drug plan will bring dramatic operational changes, they may not realize how closely they'll have to track chronically ill residents.

Providers, as well as state and federal officials, must closely monitor the transition of the chronically ill, nursing home residents and others who are dually eligible for Medicare and Medicaid, stresses a report by the California HealthCare Foundation. Another CHCF report based on the same study results from Avalere Health noted the days of one payer and one pharmacy may soon be over in many nursing homes under the new Medicare drug plan.

Dual eligibles who currently receive their medications through the Medicaid program will be switched to Medicare in 2006. The Medicare prescription drug benefit requires that those eligible for both Medicare and Medicaid receive their drug coverage from Medicare. There should be a caution-filled transition, study authors say.

"Despite many important protections extended to the dual eligible community and people with chronic conditions, CMS, policymakers, and advocates must remain vigilant in their monitoring of these vulnerable populations as they transition to private insurance plans," said Chiquita White, lead author of "The Impact of Medicare Drug Benefit Utilization Management Strategies on Individuals with Chronic Conditions."

The CHFC report "The Medicare Drug Benefit: Implications for Chronic Disease Care" can be accessed at http://www.chcf.org/documents/insurance/MedicareDrugBenefitChronicDiseaseCare.pdf.