BANGOR – Without federal legislative intervention, thousands of Maine seniors enrolled in MaineCare, Maine’s Medicaid program, will lose coverage for medications they may rely on to control anxiety, seizures, panic attacks and insomnia.
A provision buried in the 700-page Medicare Modernization Act of 2004 excludes the important and widely prescribed group of psychoactive drugs known collectively as benzodiazepines – Xanax, Valium, Halcion, Klonopin, Librium and others – from coverage under the much-touted national prescription drug benefit.
In January 2006, when Americans with both Medicare and Medicaid coverage will start having their medications paid for by Medicare, benzodiazepines will not be included. The switch will affect about 8,000 Mainers, including many in nursing homes and other residential facilities.
The drugs are not especially expensive – a 30-day supply generally costs about $30 to $40 – but because so many recipients are low-income seniors, the impact of the benzodiazepine exclusion on them is the focus of growing national concern. It is largely through the efforts of a Maine-based organization that the fine-print provision has been brought to light.
The Maine Benzodiazepine Study Group was formed three years ago to study the use, abuse and misuse of benzodiazepines. The position of the group, made up of physicians, substance abuse treatment providers, consumer health advocates and others, is that benzodiazepines are medically valuable but overprescribed, with the result that they too often wind up on the street, a favorite of recreational drug users and addicts alike.
Group members also are alert to common side effects of the drugs, especially in the elderly. These may include drowsiness, depression, memory loss, confusion and physical weakness. Studies indicate that people taking benzodiazepines are more likely to experience falls, car accidents and other potentially serious mishaps. Taken in combination with alcohol or other medications, benzodiazepines can cause life-threatening cardiac and respiratory conditions and other problems.
The drugs also are habit-forming, making it difficult, time-consuming and sometimes impossible to wean a patient to another treatment.
Despite their drawbacks, though, many health care providers and consumers say benzodiazepines are effective at treating the conditions they’re designed to remedy and, when carefully monitored, can improve daily life for patients as well as their caretakers.
The study group’s mission is to educate physicians and consumers about the appropriate use of benzodiazepines and to promote the use of effective alternatives when possible.
But the new federal exclusion is “throwing the baby out with the bath water,” according to one presenter at the organization’s second annual conference in Bangor on Monday. Robert Hayes, president of the New York-based Medicare Rights Center, called the benzodiazepine exclusion “a looming debacle” that will profoundly affect millions of Americans, especially the low-income elderly, unless it is derailed by congressional intervention.
Hayes said the Maine study group “has been a major catalyst in raising the issue” in other states and among the health care provider community.
Clearly no fan of the Medicare Modernization Act, Hayes said the Bush administration’s omnibus legislation contains “something to offend just about everybody.” He conceded, however, that the benzodiazepine exclusion is “seemingly inadvertent” and “a mistake of public policy” that came about as a result of the bill’s rapid progress through the House and Senate. Medicare bill drafters looked to existing Medicaid provisions that allow individual states to exclude a number of drugs from their coverage, including weight-loss drugs, over-the-counter drugs, and benzodiazepines, Hayes explained. In the interest of cost control and simplicity, he said, a flawed decision was made to eliminate the substances from the Medicare list, without a clear understanding of what was at stake.
Benzodiazepines were on Medicaid’s optional list because of their recognized potential for abuse, but 43 states – including Maine – include them on their list of approved drugs for Medicaid. Hayes said there is growing support in Congress for correcting the problem but it will take a focused legislative effort and strong leadership to undo the error, something that’s unlikely to occur either before the November presidential election or in the “lame duck” session between November and January.
Roseanne Pawelec, a spokeswoman at the regional office of the Centers for Medicaid and Medicare Services in Boston, said last week she is unaware of any specific proposals to change the provisions of the Medicare Modernization Act. While states’ concern over the benzodiazepine exclusion is growing, the Maine study group has been most vocal in drawing attention to the issue, she said. The Centers for Medicaid and Medicare Services will encourage state Medicaid programs to pay for any medications not covered by the Medicare benefit, Pawelec said, including benzodiazepines for the low-income elderly.
Monday’s meeting also included a presentation on the relationship between prescription drug abuse and crime in Maine and a discussion on the state’s new prescription monitoring program.
On Tuesday, the last day of the conference, the agenda was expected to be devoted to state and federal efforts to regulate the disposal of unused medications in order to protect the environment as well as to keep prescription medications away from substance abusers.
More information on the Maine Benzodiazepine Study Group, including the Medicare exclusion, can be found on the Internet at www.noemaine.org/benzo/benzo.htm