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Part D difficulties worst for nursing homes

LTC Liability Monitor, January 26, 2006

Medicare Part D arrived nearly four weeks ago, but the transition for close to one million nursing home residents into the new prescription drug benefit has been anything but smooth, according to the Chicago Tribune. Some of the emergent problems include the following:

  • Some prescription drug plans (PDP) have rejected medication claims for older, institutionalized residents suffering from depression or dementia
  • Some PDPs refuse to pay for injectable medications to treat infections, or intravenous solutions to keep residents hydrated
  • Many PDPs refuse to cover certain popular antidepressants, such as the newer Lexapro®, without prior approval, even during the initial transition period
  • Many PDPs offer step therapy protocol as a strict requirement, even though Medicare suggested it would be waived in the coming months
  • Information for as many as 100,000 dual eligible Part D beneficiaries nationwide has been lost in data exchanges, meaning they weren't properly assigned to a new drug plan by January 1

CMS continues to host weekly Part D conference calls every Tuesday from 1 p.m. to 2 p.m. Eastern time. Call 1-800-619-2457 and use password "RBDML."

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