The exclusion of benzodiazepine coverage in Medicare: Simple steps for avoiding a public health crisis
The exclusion of benzodiazepine coverage in Medicare: Simple steps for avoiding a public health crisis
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DOI：
10.1176/appi.ps.56.9.1143
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发表时间：
2005-09-01
影响因子：
3.8
通讯作者：
Soumerai, SB
中科院分区：
文献类型：
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作者：
Bambauer, KZ;Sabin, JE;Soumerai, SB
具有大量毒性的抗焦虑药物，以其过量的可能性及其高度成瘾和镇静特性而闻名（15），其作为一个例子的使用令人困惑。为了回应对药物的担忧，如被排除在MMA之外的苯二氮卓类药物，CMS于2005年6月3日向州医疗补助主任发出了一封信（16）。这封信承认MMA覆盖面存在很大差距，并要求医疗补助计划负责人通过使用州基金来覆盖MMA排除的药物来帮助解决这个问题。然而，这封信指出，如果州医疗补助计划涵盖了医疗补助计划注册者的排除药物，它必须涵盖双重合格注册者的药物。鉴于各州已经在进行“追回”支付（每月向联邦政府支付MMA保险费），他们不太可能愿意承担弥补MMA缺口的财务责任（17）。2005年6月30日，众议员本杰明·卡丹（Benjamin Cardin）（D-Md.）提出了一项法案（HR 3151）（18）由众议员吉姆拉姆斯塔德（R-Minn。标题为“修改社会保障法第十八章D部分，以消除医疗保险处方药计划所需覆盖范围中对苯二氮卓类药物的排除”，随后提交给众议院健康小组委员会。这项立法得到了医疗保险权利中心、缅因州苯二氮研究小组和哈佛医学院药物政策研究小组的大力支持，全国性的媒体也报道了这一问题（19）。该法案将删除MMA中的苯二氮卓类药物排除，并规定由卫生与公众服务部长审查苯二氮卓类药物的处方填写政策，以确保适当使用，防止滥用，并为苯二氮卓类药物处方制定质量改进和教育指南。该法案的通过将确保防止将苯二氮卓类药物排除在MMA之外的负面结果。根据美国精神病学协会（阿帕）政府关系部门主任尼古拉斯·迈耶斯的说法，阿帕非常关注排除可能对精神疾病患者产生的负面影响;因此阿帕正在试图找到一个监管或立法解决方案来解决这个问题（7），这项法案可能是阿帕正在寻找的解决方案。该法案还得到了美国医学会（20）的大力支持，以回应缅因州医学会和精神科医生的提示。
Open Forum antianxiety medication with substantial toxicity, known for its overdose potential and its highly addictive and sedative properties (15), its use as an example is perplexing. In response to concerns about medications such as benzodiazepines that were excluded from the MMA, CMS issued a letter to state Medicaid directors on June 3, 2005 (16). The letter acknowledged the large gaps in MMA coverage and asked the Medicaid directors to help fix the problem by using state funds to cover medications that the MMA excludes. The letter specified, however, that if the state Medicaid program covers an excluded medication for Medicaid enrollees, it must cover the medication for dually eligible enrollees as well. Given that states will already be making “clawback” payments (monthly payments to the federal government for MMA coverage), it is unlikely that they will want to take financial responsibility for fixing the gaps in the MMA (17). On June 30, 2005, Representative Benjamin Cardin (D-Md.) introduced a bill (HR 3151)(18) cosponsored by Representative Jim Ramstad (R-Minn.) entitled “To Amend Part D of Title XVIII of the Social Security Act to Remove the Exclusion of Benzodiazepines From Required Coverage Under the Medicare Prescription Drug Program,” which was subsequently referred to the House Subcommittee on Health. Strong encouragement for this legislation came from the Medicare Rights Center, the Maine Benzodiazepine Study Group, and the Drug Policy Research Group at Harvard Medical School, and the national press covered the issue (19). The bill would remove the benzodiazepine exclusion in the MMA and provide for the review of prescription-filling policies for benzodiazepines by the Secretary of Health and Human Services to ensure appropriate use, prevent abuse, and develop quality improvement and educational guidelines for benzodiazepine prescribing. The passage of this bill would ensure that the negative outcomes of the benzodiazepine exclusion from the MMA would be prevented. According to Nicholas Meyers, director of the American Psychiatric Association’s (APA’s) division of government relations, APA is very concerned about the negative impact that the exclusion could have on patients with mental illness; therefore APA is trying to find a regulatory or legislative solution to this problem (7), and this bill could be the solution that APA is looking for. The bill was also strongly supported by the American Medical Association (20) in response to prompts from the Maine Medical Association as well as from psychiatrists.