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Some LTC Patients Have Inadequate or No Drug Coverage

January 28, 2020

According to new study findings, which were published online in Medical Care, Medicare enrollees in long-term care (LTC) were found to have inadequate or no drug coverage. Due to this lack of coverage, LTC patients receive less medication than indicated by their health needs.  

The researchers explained that although affordable access to medications is important for patients in LTC, it was unknown prior to their study if drug coverage is universal and adequate in order to meet the needs of patients. 

We assessed enrollment in prescription drug coverage, out-of-pocket (OOP) payments and medication use in a nationwide LTC database of prescription-level, resident-level, and facility-level data for the period 2011-2013,” study authors explained. “Inadequate drug coverage was defined as ≥50% medications paid for OOP. Risk-adjusted generalized estimation equations models were estimated to identify predictors of inadequate drug coverage and total prescription fills.”  

The nationwide sample included 332,087 Medicare enrollees who were observed for more than 100 days in LTC.

According to the findings, the researchers found that Medicare Part D was the main source of drug coverage (82.4%). The next most popular drug coverage identified was private insurance (8.5%) followed by Veterans Administration (.2%). They noted that no drug coverage could be detected for 8.9% or 29,378 patients who paid for all of their medications OOP or with temporary drug payment assistance. Further, inadequate drug coverage was identified in another 2721 patients.  

“LTC Medicare enrollees without drug coverage or who had private insurance received significantly fewer prescriptions than if they had been enrolled in Medicare Part D,” the researchers explained.  

Julie Gould  


Briesacher B, Oliveri-Mui B, Chhabra B, Koethe B. Adequacy of Prescription Drug Coverage in Long-Term Care [published online ahead of print, 2020 Jan 23]. Med Care. 2020;10.1097/MLR.0000000000001291. doi:10.1097/MLR.0000000000001291

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