Acquisition costs and use of medicare part D-excluded drugs in Veterans Health Administration long-stay nursing home residents: A national, descriptive, secondary data analysis

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.