Government
AMA: Fill gaps in Medicare drug plans
■ Doctors worry that patients won't be able to pay for benzodiazepines and medications to treat substance abuse on their own.
By David Glendinning — Posted Nov. 28, 2005
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Dallas -- Medicare patients who need certain medications for psychiatric conditions or to treat substance abuse will not be able to receive government help with the bill when the new outpatient drug benefit launches in January 2006. The AMA is trying to change that.
Under a resolution that delegates adopted at the Interim Meeting earlier this month, the AMA will support legislative and administrative steps to correct what it perceives as serious shortfalls in the upcoming drug coverage. Due to provisions in the current statute, Medicare cannot pay for benzodiazepines, In addition, Medicare omitted a category of medications to treat substance abuse from its formulary guidelines for drug plans.
The AMA is calling on Congress or the Dept. of Health and Human Services to remove the prohibition on coverage of benzodiazepines. Legislation or regulation also would be necessary to make inclusion of substance-abuse medications a prerequisite for government approval of drug plans.
Physicians calling for the move said Medicare beneficiaries would be at risk for serious harm if they cannot afford their medications or if they terminate their drug regimens based on out-of-pocket costs. Some House lawmakers started taking steps to prevent this from happening by introducing a bill in June that would permit Medicare coverage of benzodiazepines.
For more than a year, the AMA has pointed out numerous serious concerns with the Medicare drug formulary process, stating that myriad vital medications might not appear on drug plans' lists of covered treatments. This resolution represents the first specific coverage shortfalls that the AMA has identified since the plan formularies became public in October.
