The exclusion of benzodiazepine coverage in medicare: simple steps for avoiding a public health crisis

When the Medicare drug benefit, the Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), goes into effect on January 1, 2006, several categories of medications will be explicitly excluded from coverage, including benzodiazepines. Approximately 24 percent of the elderly and disabled “dually eligible” Medicaid and Medicare beneficiaries who receive benzodiazepines (1), or 1.7 million people, will suddenly lose coverage for these medications when they make the transition from Medicaid to Medicare prescription drug coverage under the MMA.

Given that benzodiazepines are an effective and frequently used class of medications in the United States (2,3), why were they left off the list of covered medications? This Open Forum discusses the history of the exclusion of benzodiazepines from prescription drug coverage and the impact that the exclusion will have on Medicare beneficiaries and recommends ways to prevent or ameliorate the potential catastrophic outcomes expected from this flawed policy. [See Economic Grand Rounds, p. 1056.]