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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Phillipa on August 31, 2012, at 21:03:45
I do know that benzos are not paid for by my Medicaire. But I do know that I take low doses and look what now has been discovered about benzos. Keep dose low no problems. Phillipa
From Medscape Medical News > PsychiatryMedicare Part D Exclusion Changes Anxiety Treatment
Deborah Brauser
Authors and Disclosures
August 31, 2012 The Medicare Part D coverage exclusion for benzodiazepines (benzos), which went into effect in 2006, has had a huge effect on treating elderly patients with anxiety disorders, new research suggests.
A cohort study of more than 10,000 enrollees in healthcare plans showed that use of nonbenzodiazepine medications significantly increased for patients diagnosed with an anxiety disorder after the exclusion went into effect, "without substitution of increased behavioral care."
"The findings suggest that these patients didn't benefit from having the exclusion," lead author Michael K. Ong, MD, PhD, from the Department of Medicine at the University of California, Los Angeles, told Medscape Medical News." While there didn't seem to be any clinical effects on a population basis, these patients did end up having to pay more money out of pocket."
Dr. Michael Ong
Rationales for the exclusion's establishment include results from several studies showing that long-term use of the medications by elderly patients was associated with increased risk for falls, hip fractures, gait disturbance, and even cognitive impairment.
Although the Patient Protection and Affordable Care Act has now eliminated the Medicare Part D exclusion of benzodiazepines, that rule will not go into effect until 2013.
In addition, individual states may still try to keep some form of exclusion of the medication class in place. For example, the state auditor of California is recommending their exclusion from Medicaid coverage "in an effort to reduce budget costs," report the investigators.
"From a policy perspective, I think our study suggests that that shouldn't be the first thing on the list that people should be considering," said Dr. Ong.
The study was published in a recent issue of Psychiatric Services.First-Line Treatment
The Medicare Modernization Act (MMA) led to the provision of prescription drug coverage through Medicare Plan D starting in 2006, but it included the caveat that benzodiazepines be excluded.
"As a result, only patients with supplemental drug insurance through Medicaid or private secondary insurance, for example have access to benzodiazepine coverage," write the investigators.
"However, when used appropriately, benzodiazepines are an effective, low-cost treatment for anxiety. A major concern regarding the MMA's...exclusion was potential adverse effects on patients with anxiety disorders," they add.
The researchers note that few studies have assessed the exclusion's effects on patients overall, and none have examined the effect on those specifically with anxiety disorders, "the population most likely to be adversely affected by the policy's implementation."
The investigators examined records for 8397 people older than 64 years (mean age, 75.5 years; 79% women) enrolled in the Medicare Advantage Plan, which has the benzodiazepine exclusion, and 1657 people between the ages of 60 and 64 years (68.9% women) who had a different managed healthcare plan.
For this analysis, data on just the patients diagnosed with a new anxiety disorder in the first 6 months of 2005, 2006, or 2007 were assessed.
"If anybody was going to be affected by the exclusion, it would be these types of patients because benzodiazepines are a first-line treatment for anxiety disorders," said Dr. Ong.
Higher Costs, Reduced Treatment?
Results showed that the participants enrolled in the Medicare plan who were diagnosed with the disorder in 2005 had significantly higher rates of claims for benzodiazepines than Medicare enrollees diagnosed in 2006 or 2007 (63% vs 0.9% and 1.3%, respectively).
They also had significantly higher rates of claims for all psychotropic drugs (75.4% vs 45.9% and 50%, respectively), fewer claims for nonbenzodiazepines, and lower expenditures for all psychotropic medications.
"There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group," report the researchers.
In addition, no significant changes were found for either group in outpatient visits for behavioral care, or in hospital stays related to benzodiazepine withdrawal, or inappropriate use of the medications.
"The decline in covered claims for psychotropic medication following the implementation of the MMA may reflect an overall reduction in treatment of anxiety, given that we did not find evidence that outpatient behavioral care use had increased" as a substitute, write the investigators.
"Even if implementation of the MMA reduced inappropriate benzodiazepine use, any reductions achieved did not result in reduced hospitalizations or emergency department visits and were accompanied by slightly higher medication expenditures," they add.
Overall, the researchers note that although the exclusion may have improved care for Medicare enrollees who do not have anxiety disorders, those newly diagnosed with the disorders have faced higher costs and reduced treatment.
"These findings suggest that states seeking to reduce budget costs through restrictions of benzodiazepines may actually increase overall costs."
A "Slippery Slope"
However, Brent Forester, MD, director of the Geriatric Mood Disorders Research Program at McLean Hospital in Belmont, Massachusetts, and assistant professor of psychiatry at Harvard Medical School in Boston, has a different view on the role of these medications in an elderly population.
Dr. Brent Forester
Dr. Forester, who was not involved with this research, told Medscape Medical News that in his role as a geriatric psychiatrist, he has met with many people who have had complications from long-term use of benzodiazepines for anxiety, depression, or sleep disturbances.
"What was supposed to be a short-term treatment for insomnia or anxiety becomes a 3- or 4-year problem. They're presenting to our memory clinic with what appears to them as Alzheimer's disease; we do an evaluation and find out that they're on 2, 3, or 4 mg of a benzodiazepine; and then we spend the next 6 months or longer trying to get them off the medication, which is extraordinarily difficult," he reported.
"Lo and behold, often when they come off of the medication, they're walking better or they're no longer nearly as confused. So I come from the very biased standpoint of seeing all the adverse consequences of benzodiazepines in older adults, and think that the medications should only be used for a very short-term treatment, if at all."
Dr. Forester noted that these medications can help patients to feel calmer, "but they're not long-term solutions. And anxiety is a long-term problem."
"This study's hypothesis seemed to be that taking away this coverage was going to cause all sorts of problems in terms of the care of the patient. They found that people started substituting other psychiatric drugs for benzos. And my question is: how did that affect outcome? I don't think they really addressed that; they just looked at the immediate effect of the exclusion," he said.
He noted that mirtazapine might be a better solution for a patient who is having trouble with sleep or anxiety.
"It will also help stimulate appetite and act as an antidepressant. And it will much, much, much less likely be associated with gait disturbance and confusion," he said, adding that nonpharmacological treatments such as cognitive-behavioral psychotherapy are also effective.
Still, Dr. Forester said he is not a fan of wholesale exclusions of any type of medication, and that treatment decisions should be left to the prescriber.
"I wouldn't argue that excluding medications because of their side effects is a good thing to do. With the benzos, I can see what their rationale is for why they did it. But I wouldn't want it to become a slippery slope as they come up with other reasons to exclude other classes," he said.
"The reality is that many people take benzos and have taken them safely. But generally speaking, they don't tend to be older people who have been on them for 10 or 20 years like the people that I see. That's where we run into problems."
The study was supported by grants from the National Institute of Mental Health. Two of the study authors report several disclosures, which are listed in the original article. Dr. Ong, the other 2 study authors, and Dr. Forester have disclosed no relevant financial relationships.
Psychiatric Serv. 2012;63:637-642
Posted by Phillipa on September 1, 2012, at 10:15:39
In reply to Medicaire Part D Exclusion Effects Tx of Anxiety, posted by Phillipa on August 31, 2012, at 21:03:45
I see the return of benozos. They are only class of meds that are specific for anxiety all types, no diabetes, no weight gain, no long term side effects other than tolerance and addiction in those prone. And the other med categories all cause same. Less expensive, work right away, so many advantages!!! Finally a doc will not want an antipsychotic for anxiety. I think it's great. Phillipa
Posted by jono_in_adelaide on September 1, 2012, at 20:45:57
In reply to Medicaire Part D Exclusion Effects Tx of Anxiety, posted by Phillipa on August 31, 2012, at 21:03:45
Surely generic diazepam would be dirt cheap anyway? Does it actualy make much of a difference?
Posted by jono_in_adelaide on September 1, 2012, at 20:48:14
In reply to Re I See The Return Of Benzo Less Side Effects, posted by Phillipa on September 1, 2012, at 10:15:39
I think long term benzos for anxiety should only be prescribed after an SSRI and psychological treatment has failed, it shouldnt go back to the 70's when half the women in the western world were on Valium or Librium
Short term or occasional use if fine, but long term use should be the last resort, not the first response (and this from a long term benzo user)
Posted by Phillipa on September 1, 2012, at 23:49:50
In reply to Re: Re I See The Return Of Benzo Less Side Effects, posted by jono_in_adelaide on September 1, 2012, at 20:48:14
I feel the point of the study is it pointed out that where they thought benzos would increase injuries and decrease medical costs it did the opposite cost more money as antipsychotics were substituted and with it came diabetes, weight gain, and more confusion and broken bones. And They admitted that Ad's are not first line for anxiety that a benzos was first line. 40 some odd years of using them myself finally some validation that they are indeed safe and don't cause older people to fall. I think it's a victory. Less expensive meds, less side effects, and less unnecesary meds. Might mean that name brand can once again be used. As superior to me in response. Phillipa
Posted by jono_in_adelaide on September 2, 2012, at 0:24:33
In reply to Re: Re I See The Return Of Benzo Less Side Effects » jono_in_adelaide, posted by Phillipa on September 1, 2012, at 23:49:50
I think the majority of doctors would still feel an SSRI was first line for anxiety, and would only prescribe benzos long term when this aproach failed.
Not saying long term use of benzos is bad, or somthing to be ashamed of, just that they probably shouldnt be the first response to anxiety.
Posted by jono_in_adelaide on September 2, 2012, at 1:06:15
In reply to Re: Re I See The Return Of Benzo Less Side Effects, posted by jono_in_adelaide on September 2, 2012, at 0:24:33
Oh, and I agree with you about the antipsychotics, they should be an option of last resort, if antidepressants and benzos fail, not dolled out like candt to people with minor disorders.
I think Atarax deserves to be more widely used, it has few side effects, isnt addictive, and helps a good many people...... however, its been off patent for 30 years, so nobody bothers to promote it
Posted by Novelagent on September 2, 2012, at 10:58:09
In reply to Medicaire Part D Exclusion Effects Tx of Anxiety, posted by Phillipa on August 31, 2012, at 21:03:45
PHARMA, the lobbying group, put that provision into the Part D prescription drug benefit law because pharma doesn't make money off of benzos, which are off-patent. By switching medicare patients to more expensive, on-patent drugs, they make more money.
But benzos do increase falls in geriatric patients, sone severely, i once sadly thought my cat would do well to be on klonopin just once while she was petrified and hissing at a new dog I was introducing to her to live with to help her to acclimate to the dog. She kept falling off the bed, then I tooj her off the bed and she kept falling everywhere on the floor, it was horrible. : /. She was very, very old, 22 or 23.
Anyway, I don't know why anyone would fret about it, though. Klonopin is like $10 for a 30 day supply of 1mg, isn't it? I don't remember, it's been forever that I last had it... Maybe it was more. It's cheap, though. Medicaid always paid for mine, and I also have Medicare.
Posted by Phillipa on September 2, 2012, at 19:01:54
In reply to Re: Medicaire Part D Exclusion Effects Tx of Anxiety, posted by Novelagent on September 2, 2012, at 10:58:09
I pay cash for mine both generic and cost for both xanax & valium less than $20 a month. I wonder if klonopin is an exclusion as used also for seizure disorder? Phillipa
Posted by Chris O on September 3, 2012, at 3:15:42
In reply to Medicaire Part D Exclusion Effects Tx of Anxiety, posted by Phillipa on August 31, 2012, at 21:03:45
Unbelievable. They excluded benzos for seniors? That change is a President Bush production, right? Incredible. I sometimes feel that the only purpose of the GOP in my 45-years of life is to make me and every other American except for the wealthiest 1% suffer indefinitely. I don't think I can take another four years of their unempathic and cognitively incoherent insanity.
Posted by Novelagent on September 5, 2012, at 8:34:43
In reply to Re: Medicaire Part D Exclusion Effects Tx of Anxiety » Phillipa, posted by Chris O on September 3, 2012, at 3:15:42
People like you are the reason why I don't have the freedom in this country to go bankrupt over hospital bills. For shame.
> Unbelievable. They excluded benzos for seniors? That change is a President Bush production, right? Incredible. I sometimes feel that the only purpose of the GOP in my 45-years of life is to make me and every other American except for the wealthiest 1% suffer indefinitely. I don't think I can take another four years of their unempathic and cognitively incoherent insanity.
Posted by jono_in_adelaide on September 6, 2012, at 22:38:53
In reply to Re: Medicaire Part D Exclusion Effects Tx of Anxiety » Chris O, posted by Novelagent on September 5, 2012, at 8:34:43
Our national health scheme in Australia has a limited formulary, they will pay for diazepam and oxazepam (anxiety), alprazolam (panic disorder) temazepam and nitrazepam (insomnia) and clonazepam (epilepsy only), but they get very good prices for them
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