Washington – Two weeks before the start of the Medicare prescription-drug benefit, pharmacists and nursing homes are desperately trying to find out who will pay for the medicines taken by hundreds of thousands of the homes’ residents.
The new law relies on private insurers to deliver drug benefits to older Americans. About two- thirds of the 1.5 million residents of nursing homes are participants in both Medicare and Medicaid.
The government has randomly assigned them to private drug plans, regardless of their needs.
In many cases, nursing homes said, they do not know to which plans their patients have been assigned. As a result, they do not know who will pay the bills or what drugs will be covered. Each plan has its own list of approved drugs, known as a formulary.
Becky Kurtz, the state-appointed ombudswoman for nursing- home residents in Georgia, said: “We see a lot of confusion and a very steep learning curve for nursing-home residents and employees. Many residents are not covered for all their medications under the plan to which they have been assigned.”
By contrast, Kurtz said, “under the state Medicaid program, these residents have had nearly all their drugs covered.”
Nursing-home residents take an average of eight to nine medications a day.
The Bush administration said it had sent letters to people entitled to both Medicare and Medicaid, announcing that Medicaid coverage of their prescription drugs would end Jan. 1.
Paul Baldwin, director of the Long Term Care Pharmacy Alliance, which represents providers of prescription-drug services, said, “Nursing-home operators and pharmacies are desperately trying to figure out where these dual-eligible individuals have been assigned.”
To obtain the information, nursing homes can submit online queries to a federal website or they can send a list of beneficiaries by facsimile to the Centers for Medicare and Medicaid Services.
The agency had originally said it would “fax back” the information within three days. But on Wednesday, Medicare officials altered that pledge to 10 business days.