- The Washington Times - Monday, June 27, 2005


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, Ativan and other types of the drug benzodiazepine will have to look elsewhere for coverage or switch medication.

Finding alternatives might not be easy for the 1.7 million low-income, elderly people who take the drug and will be enrolled automatically in the new prescription-drug plan. They will depend on the states to continue paying for their benzodiazepines 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 “dual 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 benzodiazepines.

But concerns remain among medical professionals and advocates for the elderly about what would happen if some states opt to save money by excluding benzodiazepines from their Medicaid programs.

“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 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 those to promote weight loss, fertility or agents for cosmetic purposes, as well as benzodiazepines.

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 benzodiazepines, 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.

Last year, 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 Medicare Rights Center, an advocacy group, is asking Congress to amend the act to provide coverage or for Health and Human Services Secretary Michael O. Leavitt to intervene administratively. Aides to Mr. 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.”

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