ATI Analysis of Medicare Population Needs and the Critical Role of LTC Pharmacy
As many as 70 percent of individuals who reach age 65 will experience severe long-term-care (LTC) needs before they die. Those needs might range from help with managing their finances or medications, to help bathing and getting dressed. Having LTC needs does not necessarily correspond to living in a long-term care facility, however. Instead, people with LTC needs may live and receive services at home or in other community-based settings.
Unfortunately for those living outside of LTC facilities, they face barriers to getting the assistance they need. A study conducted by ATI Advisory, in partnership with the Senior Care Pharmacy Coalition (SCPC), found that “state and federal policy and health plan requirements can create barriers that restrict people aging outside facility settings from accessing long-term services and supports, including LTC pharmacy.”
As a population with high prescription drug utilization, access to LTC pharmacy is especially important to Medicare beneficiaries with LTC needs. The study found, however, that despite the pivotal role that LTC pharmacies play in the care of those with LTC needs, this role is not widely understood or acknowledged by individuals, caregivers, policymakers, and payers.
Moreover, the study found that Medicare beneficiaries with LTC needs are demographically different from those without LTC needs in several important ways. The population studied was statistically “more likely to be Black or Latinx, female, dually eligible for Medicaid, clinically complex, and have higher healthcare and prescription drug utilization than beneficiaries without LTC needs.” Addressing the barriers to access to LTC services is necessary to work toward parity in access to services, coverage for services, support for caregivers, and equity in outcomes.
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