Prescription Drug Claim Rejections for Nursing Home Residents under Medicare Part D

摘要

Some nursing facility administrators and physicians have raised concerns about the increased administrative burden of working across multiple Part D drug plans (PDPs), citing the possibility for adverse resident outcomes and financial burden on facilities when PDPs reject drug claims for residents. We examined data on claims in rejected status for one large long-term care pharmacy as of December 2006. There was considerable variation across PDPs in both rejection rates and reasons for rejections.