OIG: Payment problems remain for Medicare Part D drugs in nursing homes

Share this content:
OIG: Payment problems remain for Medicare Part D drugs in nursing homes
OIG: Payment problems remain for Medicare Part D drugs in nursing homes
Two reports from the Office of Inspector General found problems with respect to the Medicare Part D program and nursing homes. One pertained to continuing payment obstacles while the other said that nursing homes may be improperly steering residents to drug plans.

Problems persist in the payment of drugs for dual-eligible nursing home residents, according to one report. Medicare Part D drug plans do not always cover drugs prescribed to this cohort. In some cases nursing homes and long-term care pharmacies are forced to pay for the medications to meet federal regulations governing resident drug policies. Up to 45% of nursing homes cover the cost of at least one drug for dual eligibles, according to the OIG report. Roughly one-fifth of nursing home administrators and long-term care pharmacists believe that some plan formularies do not meet the needs of dual eligibles.

The OIG has asked CMS to work with plans to ensure that all necessary drugs are included in the formularies of dual-eligible nursing home residents and that drugs normally available under Medicare Part B are also available to them under Part D. Also, CMS has been asked to revamp its policy concerning prior authorization for some drugs. One in five nursing home administrators has said the process can be burdensome and can lead to delays in receiving drugs.

Meanwhile, another OIG report found that some nursing homes and pharmacies may be violating rules in their efforts to help residents choose the right drug plans.

The reports are available at http://www.oig.hhs.gov/oei/reports/oei-02-06-00190.pdf and http://www.oig.hhs.gov/oei/reports/oei-02-06-00191.pdf.