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Medicare to Expand Part D Coverage for Barbiturates and Benzodiazepines

By , August 27, 2012 11:50 am

In March of 2010, President Obama signed into law two separate Federal Acts which included modifications for Medicare and Medicaid.  The Acts are titled the Patient Protection and Affordability Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA).  

As it pertains to future Medicare coverage, one of these Federal Acts sought to update coverage guidelines for certain classes of drugs which have been traditionally excluded from coverage.  Beginning January 1, 2013, Medicare Part D will cover benzodiazepines (no restriction on use) as well as barbiturates when used in the treatment of epilepsy, cancer, or a chronic mental disorder only.  Both barbiturates and benzodiazepines are well known to have a high potential for abuse among users.

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly known as the “Beers List,” generally recommends against the use of barbiturates and benzodiazepines for the elderly.  The Beers List recommendations likely played a role in Medicare only allowing coverage for these drugs for the aforementioned specific uses.

Benzodiazepines, such as Diazepam (Valium), Restoril (Temazepam) and Ativan (Lorazepam), are most frequently prescribed to treat anxiety, insomnia and muscle relaxation.  Barbiturates such as Seconal Sodium, although FDA approved for short term use in insomnia and Fioricet (Butalbital/Acetaminophen/Caffeine), also approved by the FDA for headaches, will not be covered by Medicare for these uses.  However, barbiturates such as Phenobarbital, which is prescribed for the treatment of seizures, will now be covered by Medicare. 

The affect to MSAs is that benzodiazepines will now need to be included as well as barbiturates when they are being utilized for the treatment of epilepsy, cancer, or a chronic mental disorder.  If the injured party is utilizing the barbiturates for any other indication than those set forth as criteria for Medicare coverage, they will not need to be included in the MSA.

The bright side to the insurance industry is that the majority of barbiturates and benzodiazepines on the market have generic formulations which are fairly inexpensive.  Diazepam 5mg (Valium) is priced at roughly $.32 per tablet for the generic formulation ($2.34 per pill for brand).  Unless brand rather than generic is prescribed, these drugs should not have a significant impact on the total prescription allocation in MSAs or overall claims costs.

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