Applying the 2003 Beers update to Medicaid/Medicare enrollees

Abstract

Purpose -The purpose of this paper is to examine rates of potentially inappropriate prescribing in a population dually eligible for Medicare and Medicaid using the new 2003 Fick update, which revises the previous 1997 Beers list. Design/methodology/approach -Cross sectional retrospective review of 2003 Centers for Medicare and Medicaid Service (CMS) Medicaid Pharmacy claims data. Claims data submitted for outpatient and nursing home residents for elderly enrollees dually eligible for Medicare and Medicaid were analyzed. Potentially inappropriate drug use was assessed using the 2003 Fick update to the previous 1997 Beers list. Inappropriate use was identified based on these criteria for drugs independent of diagnosis. Findings -Of enrollees with drug use, 34 percent received an inappropriate drug per the 1997 Beers list; 47 percent per the 2003 Fick update. Hispanics had the highest percentage of drug recipients receiving an inappropriate drug in the Northeast region per the 2003 Fick update. Within therapeutic category, the number of inappropriate genitourinary products dispensed to total genitourinary products ranked the highest at 20 percent per the 2003 Fick update. Practical implications -This study examines variations in Beers drug use in the elderly dually eligible Medicare and Medicaid population in 2003 by applying the 2003 Fick et al. update of the 1997 Beers list to one of the nation's largest sources of person-specific data on prescribed drugs. Inappropriate use was identified for drugs independent of diagnosis. Of enrollees with drug use, 34 percent received an inappropriate drug per the 1997 Beers list; 47 percent per the 2003 Fick update.Within therapeutic category, the number of inappropriate genitourinary products dispensed to total genitourinary products ranked the highest at 20 percent per the 2003 Fick update. The paper's findings provide evidence that the potential use of inappropriate drugs in Hispanics should be considered separately from other ethnicity groups. Originality/value -A markedly higher rate of potentially inappropriate drug use in the elderly Medicaid population exists following the Fick update. These findings provide evidence that the potential use of inappropriate drugs in Hispanics should be considered separately from other ethnicity groups. By comparing drug use based on therapeutic category, genitourinary products were found to have the highest potential for inappropriate prescribing.

Applying the 2003 Beers Update to Elderly Medicare Enrollees in the Part D Program

“…To assess the percentage of Beers prescription fills to all prescription fills by medication therapeutic category, we retained any prescription fill for all Beers and non-Beers medications belonging to one of the nine medication categories previously addressed by Blackwell et al (2008) as Beers categories. These nine categories were analgesics and anesthetics, cardiovascular agents, central nervous system drugs, endocrine and metabolic drugs, gastrointestinal agents, genitourinary products, hematological agents, neuromuscular drugs, and respiratory agents.…”

“…Elderly patients are more susceptible to medication-induced health complications, such as depression, falls, hip fractures, and confusion, because of their poorer health status, a greater potential to receive multiple medications, and differences in how the body absorbs, metabolizes, and eliminates a medication (Bootman, Harrison, & Cox, 1997;Hanlon et al, 1997;Shrank, Polinski, & Avorn, 2007) The Beers Criteria for potentially inappropriate medication use in older adults have been used widely to identify medications that may be inappropriately prescribed for older adults (Beers, 1997;Fick et al, 2003;Blackwell, Ciborowski, Baugh, & Montgomery, 2008). Several studies indicate that medications meeting the Beers Criteria, known as Beers drugs, are particularly harmful to the elderly (U.S. General Accounting Office 1995; Blackwell, Ciborowski, Baugh, & Montgomery, 2008). Blackwell et al (2008) estimated that approximately 47% of elderly Medicare enrollees who were dually enrolled in Medicare and Medicaid received a potentially inappropriate medication.…”

“…Several studies indicate that medications meeting the Beers Criteria, known as Beers drugs, are particularly harmful to the elderly (U.S. General Accounting Office 1995; Blackwell, Ciborowski, Baugh, & Montgomery, 2008). Blackwell et al (2008) estimated that approximately 47% of elderly Medicare enrollees who were dually enrolled in Medicare and Medicaid received a potentially inappropriate medication. 1 In 2006, all Medicare beneficiaries were given the opportunity to participate in Medicare Part D, while the low income, elderly and disabled dual enrollees were automatically placed in Part D (The Henry J. Kaiser Family Foundation, 2011).…”

“…By examining Medicare's national enrollment and claims data, following implementation of the Part D program, policy makers will have more information at their disposal to assess the impact of continued Beers drugs use among all Medicare-dual and non-1 Prior to 2006, duals received drug coverage through Medicaid. Blackwell et al's (2008) findings were based on analysis of pre-2006 Medicaid data.…”

State-Based Single-Payer Health Care — A Solution for the United States?

“…Studies find that as many as 40 percent of elderly persons with insurance coverage under Medicare and Medicaid receive prescriptions each year that are not clinically necessary [81,82]. Drug events, particularly in the elderly population, constitute a large portion of the waste that results from misuse.…”