US Doctors' Ability to Prescribe Drugs for Older & Disabled Patients under New Medicare Drug Benefit

Main Category: Medicare / Medicaid / SCHIP
Article Date: 30 May 2005 - 9:00 PDT

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People with mental disorders treated with medications from a drug class that has been excluded from Medicare coverage are at risk of harm, and even danger, according to a new report released by the Medicare Rights Center, a national consumer group.

Benzodiazepines, a category of drugs commonly prescribed to treat anxiety - including dementia-related anxiety, panic and seizure disorders, and muscle spasms, have been completely excluded from the list of drugs Medicare will cover, when the new drug benefit takes effect in January 2006.

"When an obvious mistake will bring incalculable harm to Americans in need, it is the moral obligation of the White House or Congress to fix it," said Robert M. Hayes, president of the Medicare Rights Center. "Either one has the power to correct this blunder."

The legislative record of the Medicare Modernization Act (MMA) does not provide an explanation for the exclusion of benzodiazepines nor does the U.S. Department of Health and Human Services offer a rational for the policy to eliminate this class of drugs, explains the report. The drug class, benzodiazepines, includes medicines such as Xanax, Valium and Halcion.

The Medicare Rights Center recommends that:

-- Congress should amend the MMA to eliminate the benzodiazepine exclusion. In doing so, Congress could clarify that benzodiazepines may be limited in clinically appropriate ways by Part D plans to minimize the potential for misuse or abuse.

-- Alternatively, the Secretary of Health and Human Services should undertake a clinical review of the list of excludable and restrictable drugs under Medicaid and revise the list based on current clinical evidence and state practice. If the Secretary updated the list of drugs excludable under Medicaid, those updates would automatically apply to the exclusions under Medicare Part D.

-- States, through Medicaid programs and state pharmacy assistance programs, should provide coverage for benzodiazepines (and other excluded drugs) for "dual eligibles" (people with both Medicare and Medicaid coverage) and for people with low and middle incomes who will have difficulty paying for excluded drugs.

"People with Medicare deserve to know that their doctor may choose the medication that will work best for their condition, rather than worrying that an unintended mistake by Congress, compounded by the White House, will leave them without the medication they need," said Mr. Hayes.

The Medicare Rights Center report Critical Coverage: The Exclusion of Benzodiazepines under Medicare Part D, is available online at medicarerights.org/benzoreport.pdf?tr=y&auid=9084566.

Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get high-quality, affordable health care.

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New York, NY 10036
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http://www.medicarerights.org

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