Abstract
Background: Nursing home populations may consist of both short- and long-stay residents, who have different resource use profiles. Differentiating between these two populations is important in any analysis of drug costs and use.
Objective: The aim of this analysis was to provide national annualized estimates of drug acquisition costs and use of drugs excluded under Medicare Part D for dually eligible long-stay nursing home residents in the US.
Methods: This was a national, descriptive, secondary data analysis. The study population consisted of 6554 Veterans Health Administration (VHA) long-stay nursing home residents (n = 136 nursing homes), identified from the Minimum Data Set (MDS), who had an annual assessment during fiscal year (FY) 2005 linked with their 8 847 561 inpatient pharmacy claims. The study data generated were descriptive statistics of the annual drug acquisition costs and use of medications excluded under Medicare Part D. VHA therapeutic drug classes were obtained from FY 2005 national pharmacy claims linked at the individual resident level.
Results: The excluded drugs accounted for 3 036 306 of the more than 8.8 million inpatient pharmacy claims, totalling $US3 406 756 or $US526 per resident (99% CI 490, 562). Non-opioid analgesics were received by 73.3% of the residents, totalling $US352 608 or $US73 per resident; 25.3% received antitussives, decongestants, or cold and cough medications, totalling $US27 220 or $US16 per resident; 63.8% received vitamins, totalling $US281 909 or $US67 per resident; 17.7% received benzodiazepines or sedative hypnotics, totalling $US76 083 or $US66 per resident; and 64.3% received laxatives or stool softeners, totalling $US298 326 or $US71 per resident. The total acquisition cost of all drugs was $US23 782 717 for 6554 VHA nursing home residents or $US3629 per resident (99% CI 3343, 3915).
Conclusion: The cost of Medicare Part D-excluded drugs represented a fraction of the total VHA drug costs for long-stay nursing home residents, accounting for only 14.3% of all drug costs and 34.3% of the more than 8.8 million inpatient pharmacy claims. More research is needed to account for the drug dispensing and administration costs associated with these excluded classes of drugs and their efficacy. Studies of VHA drug acquisition costs provide important policy-relevant data for the Medicare Part D national price negotiation debate, particularly in a US presidential election year.
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References
Centers for Medicare & Medicaid Services. Medicare Part D versus Part B coverage issues [online]. Available from URL: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/Downloads/PartBandPartDdoc_07.27.05.pdf [Accessed 2007 Jan 22]
Edleman TS. Medicare prescription drug coverage for residents of nursing homes and assisted living facilities: special problems and concerns. Henry J. Kaiser Family Foundation [online]. Available from URL: http://www.kff.org/medicare/7432.cfm [Accessed 2007 Mar 22]
United States Pharmacopeia. Revising the Medicare model guidelines [online]. Available from URL: http://www.usp.org/hqi/mmg/revisions.html [Accessed 2008 Aug 14]
Simoni-Wastila L, Stuart BC, Shaffer T. Over-the-counter drug use by Medicare beneficiaries in nursing homes: implications for practice and policy. J Am Geriatr Soc 2006; 54: 1543–9
Doshi JA, Shaffer T, Briesacher BA. National estimates of medication use in nursing homes: findings from the 1997 Medicare current beneficiary survey and the 1996 medical expenditure survey. J Am Geriatr Soc 2005; 53: 438–43
Baugh DK, Pine PL, Blackwell S, et al. Medicaid prescription drug spending in the 1990s: a decade of change. Health Care Financ Rev 2004; 25: 5–23
French DD, Werner DC, Campbell RR, et al. A multivariate fall risk assessment model for VHA nursing homes using the minimum data set. J Am Med Dir Assoc 2007; 8: 115–22
French DD, Campbell RR, Spehar AM, et al. How well do psychotropic medications match mental health diagnoses? A national view of potential off-label prescribing in VHA nursing homes. Age Ageing 2006; 36: 107–8
Department of Veterans Affairs. VHA directive 2005-060, December 7, 2005. Implementation of the Medicare Prospective Payment System (PPS) assessment form (MPAF) [online]. Available from URL: http://wwwl.va.gov/VHAPUBLICATIONS/ViewPublication.asp?.pub_ID=1356 [Accessed 2008 Jan 14]
Department of Veterans Affairs. VHA directive 2005-061, December 7, 2005. VA nursing home care unit (NHCU) admission criteria, service codes, and discharge criteria [online]. Available from URL: http://wwwl.va.gov/geriatricsshg/docs/VANHCUadmission05.pdf [Accessed 2008 Jan 14]
Department of Veterans Affairs. Resident Assessment Instrument Minimum Data Set (RAI/MDS). VHA directive 2001-029, May 10, 2001 [online]. Available from URL: http://www.virecresearch.va.gov/DataSourcesName/RAI-MDS/RAI-MDS.htm [Accessed 2008 Aug 14]
Centers for Medicare & Medicaid Services. Revised long-term care Resident Assessment Instrument (RAI) user’s manual for the Minimum Data Set (MDS) version 2.0. [online]. Available from URL: http://www.cms.hhs.gov/nursinghomequalityinits/20_NHQIMDS20.asp [Accessed 2008 Aug 14]
Morris J, Hawes C, Murphy K, et al. Resident Assessment Instrument training manual and resource guide. U.S. Department of Health and Human Services, Health Care Financing Administration. Springfield (VA): National Technical Information Service, 1991 Jan
Morris J, Murphy K, Nonemaker S. Long Term Care Resident Assessment Instrument user’s manual for version 2.0. U.S. Department of Health and Human Services, Health Care Financing Administration. Springfield (VA): National Technical Information Service, 1995 Oct
Nonemaker S, Murphy K, Morris, J. Long Term Care Resident Assessment Instrument training materials for version 2.0 (standardized training package), November 1995 [online]. Available from URL: http://www.interrai.org/section/view/?.fnode=17 [Accessed 2007 Mar 23]
VIReC research user guide: VHA Decision Support System (DSS) Clinical National Data Extracts (NDES), FY2000-FY2004 [online]. Available from URL: http://www.virec.research.va.gov/References/RUG/RUGDSS00-04.pdf [Accessed 2008 Jan 14]
United States Government Accountability Office (GAO). VA long term care: trends and planning challenges to providing nursing home care to veterans. GAO-06-333T; Jan 2006 [online]. Available from URL: http://www.gao.gov/new.items/d06333t.pdf [Accessed 2008 Jan 14]
United States Government Accountability Office (GAO). VA long-term care: oversight of nursing home program impeded by data gaps. GAO-05-65; Nov 2004 [online]. Available from URL: http://www.gao.gov/new.items/d0565.pdf [Accessed 2008 Jan 14]
French DD, Campbell RR, Spehar AM, et al. Drug cost and use in VHA nursing homes: a national overview of long-stay residents. J Am Med Dir Assoc 2007; 8: 515–8
United States Department of Veterans Affairs, Pharmacy Benefits Management Services. VHA drug prices, contracts and agreements [online]. Available from URL: http://www.pbm.va.gov/ContractsAndAgreements.aspx [Accessed 2007 Mar 23]
Congressional Budget Office (CBO). Prescription drug pricing in the private sector. January 2007 [online]. Available from URL: http://www.cbo.gov/ftpdocs/77xx/doc7715/01-03-PrescriptionDrug.pdf [Accessed 2007 Mar 23]
U.S. Department of Veterans Affairs, Pharmacy Benefits Management, Strategic Healthcare Group. National Formulary questions [online]. Available from URL: http://www.pbm.va.gov/natform/fequentlyasked.htm [Accessed 2007 Mar 23]
U.S. Department of Veterans Affairs, Pharmacy Benefits Management Services. National Formulary [online]. Available from URL: http://www.pbm.va.gov/NationalFormulary.aspx [Accessed 2007 Mar 23]
VHA national drug file (Microsoft Access™ database) [online]. Available from URL: http://www.pbm.va.gov/NationalFormulary.aspx [Accessed 2008 Jan 14]
Hamrick I, Nye AM, Gardner CK. Nursing home medication administration cost minimization analysis. J Am Med Dir Assoc 2007; 8: 173–7
Acknowledgements
The research reported here was supported by the resources and use of facilities at the James A. Haley Veterans’ Hospital (Tampa, FL, USA) and the Veterans Integrated System Network 8 (VISN-8) Patient Safety Center of Inquiry, Department of Veterans Affairs, Veterans Health Administration (VHA). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Dr French is a full-time employee of the Department of Veterans Affairs, VISN-8. Dr Rubenstein received research support provided by the Veterans Affairs Greater Los Angeles Healthcare System (GLAHS) Geriatric Research, Education and Clinical Center (GRECC), Sepulveda and West Los Angeles Divisions.
The authors have no conflicts of interest that are directly relevant to the content of this study.
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French, D.D., Campbell, R.R., Rubenstein, L.Z. et al. Acquisition Costs and Use of Medicare Part D-Excluded Drugs in Veterans Health Administration Long-Stay Nursing Home Residents. Drugs Aging 25, 855–860 (2008). https://doi.org/10.2165/00002512-200825100-00004
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DOI: https://doi.org/10.2165/00002512-200825100-00004