Part D Medicare Won't Cover Benzos

Discussion in 'Fibromyalgia Main Forum' started by Mikie, Mar 1, 2006.

  1. Mikie

    Mikie Moderator

    I just saw this article and thought y'all might like to see it. I am switching my Rx for Klonopin (clonazepam) to COSTCO where it is less than half what Albertson's charges.

    Love, Mikie

    US prescription plan won't cover 'benzos'
    Advocates worry patients risk losing a class of drugs
    By Associated Press | June 28, 2005

    WASHINGTON -- When the new federal prescription drug benefit kicks in next year, it will not cover a category of drugs commonly used to treat anxiety, insomnia, and seizures.

    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 medication. That 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" -- on Jan. 1, but with no guarantee.

    The Centers for Medicare and Medicaid Services recently urged state Medicaid directors to provide coverage 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 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, of the American Society of Consultant Pharmacists. The American Medical Association took note of those risks when it pledged 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 and fertility, agents for cosmetic purposes, and benzos.

    Basically, Congress excluded all drugs that states were entitled to omit from their Medicaid programs. All states provide some coverage for benzos, though they don't have to. Last year, they spent $57 million on that category of drugs for the dual-eligible.

    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.
  2. 69mach1

    69mach1 New Member

    i don't know how to paste these articles nor feel like typing them all up...

    but this is exactly what i have been my pharmacy and i was forunate to be able to qualify for medi-cal at this time...but i also have to do a spend down or i willnot qualify for it...and right now after they take some moenyout of my ssdi check it leaves &764.00..oh boy i will be in trouble if i don't get my section 8 voucher and when my child support and arearages get all caught up some year...

  3. Mikie

    Mikie Moderator

    Love, Mikie
  4. Mikie

    Mikie Moderator

    To exclude some meds from the formularies, but to refuse to include a whole family of meds which help so many people, is cruel.

    I agree that the pharmaceutical company lobbiests probably had a huge hand in developing the new Part D. It is going to be a windfall for the drug companies at taxpayer expense and at the expense of those who are forced to take the Part D and who will not benefit from it.

    Love, Mikie
  5. mildred623

    mildred623 New Member

    I just wanted to share my experience with this. I have taken Xanax for probably the past 5 or 6 yrs. I have always had Medicaid that would cover all my RX's.

    Then the first of the year was told Medicaid would not cover anything. All RX's had to go on Medicare.

    Well in January the pharmacy told me Medicare would not cover my Xanax so I had to pay for them. Cost me $35.00. Was upset, but what are you gonna do when you need your meds?

    Went to the pharmacy to fill them in Feb. and they cost $0.00. Come to find out they put them through on my Medicaid and they paid for them.

    The rest of my meds went through on Medicare. So I guess what I'm getting at is if any of you have Medicaid and Medicare then you should check with the pharmacy if these meds can go through on your Medicaid.
  6. Mikie

    Mikie Moderator

    Perhaps Medicaid is picking up what Medicare will not cover. This is good news and I'm happy for you.

    Love, Mikie

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