CommunityPam's House Blend

If you're in a nursing home and needs meds, Bush is screwing you



Roz Jackson, an aide at Asbury Methodist Village in Gaithersburg, Md., prepares to give Beatrice Kruhm her daily medications. What’s Kruhm going to do now? Photo: Carol T. Powers/for NYT

Bush and those writing the new Medicare prescription laws clearly weren’t thinking about how the vast number of seniors with cognitive disabilities (that are supposed to “shop around” for cheaper drugs under the complex plan) were going to handle this new program. Are the lawmakers just plain stupid? Oh, never mind. (NYT):

-term care express serious concern that the new Medicare law will be unworkable for most of the 1.5 million Americans who live in nursing homes.

Nursing home residents take large numbers of prescription drugs, an average of eight a day. But many have physical disabilities and brain disorders that impair their memory and judgment. So they cannot easily shop around for insurance plans to find the best bargains on their drugs, as other Medicare beneficiaries are supposed to do.

Federal and state officials, pharmacists and nursing home directors said they had no idea how these patients would obtain their medicines under the new program, which begins in January 2006.

Nobody knows where they’re going to get their drugs from,” said Stanton G. Ades, senior vice president of NeighborCare, a company in Baltimore that supplies drugs to more than 1,500 nursing homes and assisted living centers in 32 states. The role of such long-term care pharmacies under the new law is unclear.

A month’s supply of each drug prescribed for each patient is kept in a separate little box labeled with the patient’s name. The cart has 165 boxes, indicating an average of about eight prescriptions for each resident. Since each prescription may call for 2 or 3 pills a day, a patient may be taking 20 to 30 pills a day.

The nurses keep detailed logs that show every pill given to every patient. NeighborCare, which supplies drugs for all 250 patients in the home, continually reviews those records to ensure that patients are taking the right drugs in the proper doses.

By contrast, the new law relies on private health plans to provide drug benefits to the elderly. Each Medicare beneficiary will have a choice of two or more government-subsidized plans. Each plan can establish its own list of approved drugs, known as a formulary, and its own network of retail pharmacies.

Premiums, generally expected to average $35 a month, can vary from plan to plan. The premise of the law is that Medicare beneficiaries will carefully compare these plans and enroll in the ones that best meet their needs.

Aetna, for example, might offer a Medicare drug plan, dispensing medications at discounted prices through retail pharmacies around the country. But the network would not necessarily include NeighborCare, the supplier at Asbury Village.

Bush administration officials said they were seeking ways to meet the special needs of nursing home residents and recognized the value of long-term care pharmacies. Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, said the administration would ensure that beneficiaries had access to “all medically necessary drugs.” Moreover, Mr. McClellan said drug plans cannot “discriminate against any particular type of beneficiaries.” In a preamble to the proposed Medicare rules, the government said access to such pharmacies “should be preserved,” but did not say how.

The new Medicare benefit, as envisioned by Congress, will be delivered by insurance companies and pharmacy benefit managers like Medco Health Solutions and Express Scripts, through drug stores like Walgreens and CVS. But the typical retail drugstore or pharmacy benefit manager has little experience with nursing home residents.

Medco manages drug benefits for 60 million people of all ages. In an interview, its president, David B. Snow Jr., said none of them were in nursing homes.

Another benefit manager, Express Scripts, serves 55 million people. A vice president of the company, Stephen E. Littlejohn, said nursing homes were “not on our radar screen.”

Walgreens operates 4,623 drugstores in 44 states, but a spokesman, Michael Polzin, said it had no program to supply drugs to nursing homes.

Well there’s a program that’s ready to roll out.

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Pam Spaulding

Pam Spaulding