AP/Las Vegas Sun Examines Exclusion of Some Anxiety Medications From Medicare Prescription Drug Benefit
The AP/Las Vegas Sun on Sunday examined how the new Medicare prescription drug benefit will not cover a category of drugs called benzodiazepines, which are also known as benzos and are used to treat anxiety, insomnia and seizures.
According to the AP/Sun, benzos are considered highly addictive and thus not suitable for long-term treatment. Most drugs in the category are included in the Beers List, a guide that identifies medications that should not be given to the elderly, Dennis Smith, director of CMS' Center for Medicaid and State Operations, said.
Many state Medicaid programs provide coverage of benzos and last year spent $57 million on the drugs for about 1.7 million dual eligibles, according to the AP/Sun. In a recent letter to state Medicaid directors, Smith said that because "the potential exists for severe adverse effects in patients who abruptly discontinue the use of these drugs and because care must be taken to transition individuals to safer alternatives, states that currently provide coverage of these drugs for the elderly may wish to continue to do so after the transition to Medicare in order to maintain continuity of care for this population."
State Medicaid programs that provide coverage for benzos to dual eligibles will receive federal funds. Medicare beneficiaries who do not qualify for Medicaid will be required to pay for benzos out of pocket, find a replacement medication that is covered under the new Medicare benefit or pay higher premiums for supplemental prescription drug coverage.
Some providers and advocates for the elderly have expressed concern that states could decide to discontinue Medicaid coverage of benzos for dual eligibles to reduce costs. "Stopping the therapy abruptly can lead to seizures and dangerous, life-threatening problems," Thomas Clark, policy director for the American Society of Consultant Pharmacists, said.
The Medicare Rights Center said that the exclusion of benzos from the Medicare drug benefit could harm beneficiaries if it resulted in "rapid, unphased medication changes." Robert Hayes, the group's president, said that the exclusion is "at the very least ... discriminatory."
The group is asking Congress to amend the 2003 Medicare law to include benzos in the drug benefit or for HHS Secretary Mike Leavitt to intervene. However, aides to Leavitt have said he does not have the authority to change the coverage.
The American Medical Association on Tuesday passed a resolution to "work to end the exclusion of medications of the benzodiazepine class from (federal) reimbursement" (Freking, AP/Las Vegas Sun, 6/26).
In related news, the Access to Benefits Coalition on Friday released a study saying that "in-reach," a strategy in which established lists are used to contact potential beneficiaries, could be one of the "most cost-effective strategies" for enrolling low-income Medicare beneficiaries in the new drug benefit, CQ HealthBeat reports. Conducted by the Bridgespan Group, the study examined best practices from a number of groups that reach out to low-income populations, which are considered difficult to contact.
According to the study, successful outreach strategies cost between $30 and $280 per beneficiary, with programs targeting non-English speakers costing more. The less-expensive programs use lists of likely eligible beneficiaries. According to the study, 45% of a program's cost is used for one-on-one help and enrollment and the rest is spent on reaching out to potential beneficiaries (CQ HealthBeat, 6/24).
Additional information on the Medicare drug benefit is available online.