Executive Decisions with Tom Clark

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The Medicare Modernization Act of 2003 will produce dramatic payment changes for medications used in long-term care settings. To get a better understanding of the changes ahead, we caught up with Thomas R. Clark, R.Ph., MHS, Policy and Advocacy director for the American Society of Consultant Pharmacists, Alexandria, VA.

Q. How is the new Medicare law going to affect long-term care pharmacy?
A. Beginning in 2006, individuals who are covered by both Medicare and Medicaid (dual eligibles) will receive their drug benefit from Medicare instead of Medicaid. Since Medicaid now provides a drug benefit for about two-thirds of all nursing facility residents, this will be a major shift. The structure of this new benefit becomes critical to ensuring that nursing facility residents have access to medically necessary medications.
ASCP is working now with the Centers for Medicare & Medicaid Services to help address some critical issues relating to the new benefit, especially for low-income individuals, including:
• Which drugs will be covered on the formularies of the new prescription drug plans that will implement the drug benefit?
• What if a nursing home resident needs a medication that is not on the formulary?
• Will alternative dosage forms of medications, including injectable medications such as antibiotics, be readily available for nursing home residents?
• Who is supposed to pay for medically necessary medications for nursing home residents that are not included on the formulary of the prescription drug plans?

Q. How will the drug discount card program impact long-term care?
A. CMS regulations anticipate that the standard drug discount card for Medicare beneficiaries, which is to be implemented on June 1, 2004, will not be used in the nursing facility setting. The transitional drug assistance card, which provides $600 of cash assistance per year, will be available to nursing home residents through a CMS special endorsement. This may be useful for those private pay residents who are in the process of spending down assets to qualify for Medicaid.
 The ASCP web site (www.ascp.com) has much more extensive information about the drug discount cards, transitional drug assistance cards, and other aspects of the new law.