Medicare Bill Will Cover Benzodiazepines

Chris Ballas, M.D. Health Guide
  • The House of Representatives recently passed a Medicare bill that reduces the copay for Medicare patients from 50% to 20%, the rate it is for all other medical specialties.


    That may not seem like a big deal—and if it doesn't, you probably don't have Medicare.


    An even more interesting provision of this bill is that it will require all Medicare Part D pharmacy plans to cover almost all medications—and this means benzodiazepines. 


    Currently, benzodiazepines are often not covered, regardless of whether they are generic or not. More generally, the bill calls for the drug plans to cover "all or substantially all" medications that are available within the main therapeutic categories (psychosis, depression, etc.)

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    Finally, it blocked the planned reduction of 10% in the payments Medicare made to doctors. This is important for family doctors, who are often the only physicians treating a person's psychiatric illness; a fee reduction might prompt the doctor not to take on Medicare patients at all.


    Back in March, the House also passed the The Paul Wellstone Mental Health and Addiction Equity Act, which brought into parity the psychiatric and physical medical services. This parity would apply to annual and lifetime limits, and parity in deductibles and copays.  Copays were previously as high as 50%for psychiatric illnesses, and are now 20%, as they are for most medical illnesses. Additionally, it called for parity with respect to number of visits. The increases in cost which are likely to result from this bill are in part paid for by pharmaceutical companies, who will have higher "rebates" that they will have to pay to have their drugs placed on the Medicaid formularies.  (You didn't think they decided formularies based on science, did you?)


    This parity bill is not the famous "Mental Health Parity Act" of 2007 passed by the Senate.  The main difference between the two is that this bill requires to cover all DSM diagnoses, if they are covering any.  In other words,  it does not allow the managed care companies to pick and choose which diagnosis they will cover, and which they won't.  The idea is that insurance companies should not be determining what is a real disease and what is not—if the medical community has agreed that there's enough science to support a diagnosis, then the insurance companies can't override that consensus using less science.


    Previously, certain disorders (bipolar, schizophrenia, etc) were considered equivalent to cancer, and had parity in coverage.  Other psychiatric diagnoses, such as eating disorders and addiction, had various limits on outpatient and inpatient care.


Published On: July 02, 2008