Effect of Medicare Part D Benzodiazepine Exclusion on Psychotropic Use in Benzodiazepine Users

Authors

  • Michael K. Ong MD, PhD,

    Corresponding author
    • Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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  • Haiyong Xu PhD,

    1. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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  • Lily Zhang MS,

    1. Center for Health Services and Society, University of California at Los Angeles, Los Angeles, California
    2. Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
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  • Francisca Azocar PhD,

    1. OptumHealth Behavioral Solutions, San Francisco, California
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  • Susan L. Ettner PhD

    1. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
    2. Department of Health Services, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
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Address correspondence to Michael K. Ong, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90024. E-mail: michael.ong@ucla.edu

Abstract

Objectives

To evaluate the effect of the Medicare benzodiazepine coverage exclusion on psychotropic use of benzodiazepine users.

Design

Pre–post design with concurrent control group.

Setting

General community.

Participants

Intervention and comparison cohorts of individuals drawn from the same insurer who were prescribed benzodiazepines through the end of 2005. Intervention participants (n = 19,339) were elderly adults from a large, national Medicare Advantage plan subject to benzodiazepine exclusion as a result of the Medicare Modernization Act (MMA). Comparison participants (n = 3,488) were near-elderly individuals enrolled in a managed care plan not subject to the MMA benzodiazepine exclusion.

Measurements

Any psychotropic drug use and expenditures.

Results

In the intervention cohort, benzodiazepine use and expenditures significantly declined from 100% and $134 in 2005 to 74.8% and $59, respectively, in 2007. Nonbenzodiazepine psychotropic drug use and expenditures significantly increased from 35.8% and $163 in 2005 to 39.5% and $207, respectively, in 2007. In the comparison cohort, benzodiazepine use and expenditures also significantly declined from 100% and $173 in 2005 to 57.5% and $105, respectively, in 2007, but nonbenzodiazepine psychotropic drug use and expenditures significantly declined from 55.4% and $647 in 2005 to 45.1% and $572, respectively, in 2007. Changes in antidepressant and anxiolytic use were the primary cause of changes in nonbenzodiazepine psychotropic drugs in both cohorts.

Conclusion

Use of benzodiazepines continued in elderly adults despite negative financial incentives, possibly because of the low costs of such medications. Although some substitution occurred with antidepressants and anxiolytics, the magnitude of this increase did not fully offset the reduction in benzodiazepine use.

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