States asked to continue covering certain drugs that new Medicare benefit won't provide

Monday, June 27th 2005, 9:35 am

By: News On 6

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, Ativan 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 ``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 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 benzodiazapine exclusion raises serious concerns that people with Medicare who sign up for Part D plans will receive inappropriate care for conditions that are common in older and disabled adults,'' the group said. Part D plans make up the Medicare prescription drug program.

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.