title: Medicare Part D benzodiazepine exclusion and use of psychotropic medication by patients with new anxiety disorders.
abstract: 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.
authors.affiliation: Department of Medicine, University of California, Los Angeles (UCLA), 911 Broxton Ave., First Floor, Los Angeles, CA 90024, USA. michael.ong@ucla.edu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Ong
authors.forename: Lily
authors.initials: L
authors.lastname: Zhang
authors.forename: Haiyong
authors.initials: H
authors.lastname: Xu
authors.forename: Francisca
authors.initials: F
authors.lastname: Azocar
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000191:economics / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy*; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use*; D014481:United States
chemical_list: D014151:Anti-Anxiety Agents; D011619:Psychotropic Drugs; D001569:Benzodiazepines