Medicare Part D Benzodiazepine Exclusion and Use of Psychotropic Medication by Patients With New Anxiety Disorders
Medicare Part D drug plans specifically exclude coverage of benzodiazepines, largely because of concerns over safety and inappropriate use. However, benzodiazepines are an effective, low-cost treatment for anxiety. This study used national data to examine the effects of the benzodiazepine exclusion...
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| Published in | Psychiatric services (Washington, D.C.) Vol. 63; no. 7; pp. 637 - 642 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Arlington, VA
American Psychiatric Association
01.07.2012
American Psychiatric Publishing, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1075-2730 1557-9700 1557-9700 |
| DOI | 10.1176/appi.ps.201100331 |
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| Abstract | Medicare Part D drug plans specifically exclude coverage of benzodiazepines, largely because of concerns over safety and inappropriate use. However, benzodiazepines are an effective, low-cost treatment for anxiety. This study used national data to examine the effects of the benzodiazepine exclusion on Medicare enrollees with a new diagnosis of an anxiety disorder.
Objective:The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders.
Methods:The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan.
Results:Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort.
Conclusions:Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication. (Psychiatric Services 63:637–642, 2012; doi: 10.1176/appi.ps.201100331) |
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| AbstractList | Objective: The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders. Methods: The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60-64) enrollees (N=1,657) of a managed care plan. Results: Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort. Conclusions: Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication. (Psychiatric Services 63:637-642, 2012; doi: 10.1176/appi.ps.201100331) The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders.OBJECTIVEThe Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders.The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan.METHODSThe authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan.Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort.RESULTSMedicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort.Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication.CONCLUSIONSAmong elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication. Medicare Part D drug plans specifically exclude coverage of benzodiazepines, largely because of concerns over safety and inappropriate use. However, benzodiazepines are an effective, low-cost treatment for anxiety. This study used national data to examine the effects of the benzodiazepine exclusion on Medicare enrollees with a new diagnosis of an anxiety disorder. Objective:The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders. Methods:The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan. Results:Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort. Conclusions:Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication. (Psychiatric Services 63:637–642, 2012; doi: 10.1176/appi.ps.201100331) The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders. The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan. Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort. Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication. |
| Author | Zhang, Lily Ong, Michael K Xu, Haiyong Azocar, Francisca Ettner, Susan L |
| Author_xml | – sequence: 1 givenname: Michael K surname: Ong fullname: Ong, Michael K email: michael.ong@ucla.edu – sequence: 2 givenname: Lily surname: Zhang fullname: Zhang, Lily email: michael.ong@ucla.edu – sequence: 3 givenname: Haiyong surname: Xu fullname: Xu, Haiyong email: michael.ong@ucla.edu – sequence: 4 givenname: Francisca surname: Azocar fullname: Azocar, Francisca email: michael.ong@ucla.edu – sequence: 5 givenname: Susan L surname: Ettner fullname: Ettner, Susan L email: michael.ong@ucla.edu |
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| CitedBy_id | crossref_primary_10_4140_TCP_n_2013_538 crossref_primary_10_1111_1475_6773_12534 crossref_primary_10_2105_AJPH_2016_303382 crossref_primary_10_1016_j_clinthera_2013_02_024 crossref_primary_10_1080_13696998_2018_1466710 crossref_primary_10_1176_appi_ps_201500482 crossref_primary_10_1002_14651858_CD011703_pub2 crossref_primary_10_1016_j_sapharm_2013_06_008 crossref_primary_10_1681_ASN_2018080811 crossref_primary_10_1111_jgs_15740 |
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| Snippet | Medicare Part D drug plans specifically exclude coverage of benzodiazepines, largely because of concerns over safety and inappropriate use. However,... The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an... Objective: The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines... |
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| SubjectTerms | Aged Aged, 80 and over Anti-Anxiety Agents - economics Anti-Anxiety Agents - therapeutic use Anxiety Anxiety Disorders - drug therapy Benzodiazepines - economics Benzodiazepines - therapeutic use Biological and medical sciences Cohort Studies Drug therapy Female Humans Insurance Coverage - statistics & numerical data Male Managed Care Programs - statistics & numerical data Medical sciences Medicare Medicare Part D - statistics & numerical data Mental disorders Middle Aged Practice Patterns, Physicians' - statistics & numerical data Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychotropic drugs Psychotropic Drugs - economics Psychotropic Drugs - therapeutic use Social psychiatry. Ethnopsychiatry United States |
| Title | Medicare Part D Benzodiazepine Exclusion and Use of Psychotropic Medication by Patients With New Anxiety Disorders |
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