By KEVIN FREKING
ASSOCIATED PRESS
WASHINGTON (AP) - When the
federal government's new prescription drug benefit kicks in next year, it will
not cover a category of drugs commonly used to treat anxiety, insomnia and
seizures.
That means those disabled
and elderly people on Medicare who take Xanax, Valium, Atvian and other types
of the drug benzodiazepine will have to look elsewhere for coverage or switch
to a different, less addictive medication.
Finding other alternatives
may not be easy for the 1.7 million low-income, elderly people who take the
drug and will be automatically enrolled in the new prescription drug plan. They
will depend on the states to continue paying for their benzodiazepines -
"benzos" for short - on Jan. 1, but with no guarantee.
The Centers for Medicare and
Medicaid Services recently urged state Medicaid directors to provide coverage
of the drugs for the 6.3 million people who are "duel eligible" for
prescription aid under the Medicaid and Medicare programs.
If states agree, they will
continue to get federal matching funds when they pay for benzos.
But concerns remain among
medical professionals and advocates for the elderly about what would happen if
some states opt to save money by excluding benzos from their Medicaid program
for the poor.
"Stopping the therapy
abruptly can lead to seizures and dangerous, life-threatening problems,"
said Thomas Clark, policy director for the American Society of Consultant Pharmacists.
The American Medical
Association took note of those risks when it passed a resolution Tuesday
pledging to "work to end the exclusion of medications of the
benzodiazepine class from (federal) reimbursement."When Congress approved
the Medicare Modernization Act two years ago, it specifically excluded several
categories of drugs, including drugs to promote weight loss, fertility or
agents for cosmetic purposes, as well as benzos.
Basically, Congress excluded
from the new benefit all drugs that states were entitled to omit from their
Medicaid program. All states provide some level of coverage for benzos, even
though they don't have to. Last year, they spent $57 million on that category
of drugs for the dual-eligible population.
Elderly people who don't
qualify for Medicaid will have to pay for the drugs on their own as they do
now, find a replacement that is part of the new Medicare benefit or pay higher
premiums for additional prescription coverage.
In 2004, the entire
benzodiazepine class accounted for about $702.8 million in sales in the United States
,
according to IMS Health, a leading consultant to pharmaceutical companies. The
75.6 million prescriptions that year made it the 11th largest therapeutic class
based on total dispensed prescriptions.
The Medicare
Rights
Center
, an advocacy
group, is asking Congress to amend the act to provide coverage or for Health
and Human Services Secretary Michael Leavitt to intervene administratively.
Aides to Leavitt say he lacks the authority to do that.
The group said the exclusion
could be harmful for patients if it resulted in "rapid, unphased
medication changes."
The drugs are not without
controversy. Because they are so addictive, they are usually unsuitable for
long-term treatments. The vast majority is included in the Beers' List, a guide
that identifies medications that should be avoided by the elderly, said Dennis
Smith, director of the federal Center for Medicaid and State Operations.
"However, 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,"
Smith said in his letter to Medicaid directors.
Dr. Donna Fick, associate
professor at the Penn
State
University
School
of Nursing, helped
update the Beers' List two years ago.
"I would never say
someone should never be on a certain class of drugs. That's up to a doctor who
can see the whole picture, but I generally think they should be avoided in
older adults," she said.
Dr. Stevan Gressitt, medical
director of a mental health and substance-abuse treatment facility in Bangor
,
Maine
,
said benzos are sometimes appropriate. He formed a study group of doctors and
other health care professionals to educate patients and the medical community about
the risks and benefits of the drugs.
"The cutoff is no way
to address the problem," Gressitt said. "... For some patients, there
will be dissatisfaction because the other drugs may not be as effective."
Robert
Hayes, president of the Medicare
Rights
Center
,
said covering the drugs through Medicaid for some elderly people but not for
others makes little sense. "At the very least, it's discriminatory,"
he said.
