The Medicare Part D drug benefit has been an uncomfortable fit for nursing homes, a new study from the Medicare Payment Advisory Commission suggests.

Because of the acuity level of nursing home residents the benefit has encountered challenges in long-term care settings. Formularies’ transition coverage requirements and utilization management requirements, for example, have posed problems for this population, the study noted. MedPAC contracted with Harvard Medical School for the study.

The study raised other ongoing tensions between Medicare Part D and nursing homes. For example, while beneficiaries are free to choose their plans, the government has restrained providers from helping residents, many of whom are cognitively impaired, from choosing a plan that meets their needs. (Officials recently clarified that providers may assist to a greater level.) There has also been the financial cost on long-term care pharmacies, which are obligated to dispense prescribed drugs to beneficiaries, regardless of whether their plans cover the medications.

To see the study, go to http://www.medpac.gov/documents/Jun07_Part_D_contractor.pdf.