Dangerous Drugs

Monday, April 8, 2013

We have been getting a lot of concerned calls about medications no longer allowed while on Medicare.

A few drugs you may recognize include Ambien, Lunesta, most muscle relaxers ( Flexeril, Soma, Robaxin, Skelaxin), Estrogens and some antibiotics like Nitrofurantoin ( Macrobid).

Most of these medications have been limited to no more than a 90 day supply in a the year 2013.  This has caused a great deal of concern from some of our patients unfortunately.  This is a chance to explain some of these changes.

There is a list of dangerous drugs for seniors called, ironically, the Beers list.  It is a very extensive list of medications with potentially harmful side effects.  The key word is “potentially” because many people have survived years on these medications without incident.  The problem is that enough people have had troubles such as strokes, blood clots and heart attacks from estrogens.  People get up confused at night while taking Ambien, Amitriptyline, Muscle relaxers and fall causing hip fractures and concussions or they may have automobile accidents and injure other people.  People taking Nitrofurantoin for bladder infections have developed kidney and lung toxicity.  There have been enough complications from these medications that Medicare had to step in to contain costs.  It’s estimated that medications like these cost $7.2 billion in 2000-2001 alone.

The Beers List is extensive and long.  Medicare has finally taken notice and mandated that physicians adhere to some of these medications this year, not all.  Any prescriber that writes over the allowed amount is penalized.  You may find some physicians are not aware of these new changes and are still writing them but in time they will probably not be taking Medicare or their license may be called into question.  Medicare also runs a STARS rating program of health plans and physicians.  These ratings are how you will likely pick you provider in the future based on quality scores.  Some of the scores are valid and some are quite arbitrary, but this is common with government programs and it’s how things are going to be done.

If you are taking one of these High Risk Medications we will work very hard to find an alternative that works as well, is safer, and one that you are satisfied with.  It is devouring a great deal of our clinic time and resources trying to help reasonable people find these alternatives.  There will be some that fight this change and all I can do is apologize, but our clinic will always try to do what is right before what is popular.

If you take one of these medications and call Medicare or Healthspring insurance about the drug coverage, they will likely tell you it’s covered.  This has already happened. It is classic government logic.  They are holding us to a standard already that they are not themselves prepared to manage properly.  This is most unfortunate as it creates even more uncertainty and confusion about an already stressful topic.

In addition to all the Medicare changes this year, the State of Tennessee has mandated verifying the status of all prescriptions for controlled substances: Hydrocodone ( Lortab ), Benzodiazepines ( Xanax, Klonopin, Valium...) , Sleep Medications ( Ambien, Lunesta...) and other controlled drugs.   This requires entering your information in the Controlled Substances Monitoring Database (CSMD).  This program will display every controlled drug you have filled, where you filled it, when you filled, how many prescribed, who prescribed it.  This is an effort to curb the epidemic of prescription drug abuse in Tennessee.  

To comply with the law and to be sure we are fully compliant with its intent, we require an office visit every 3 months to evaluate the need for the drug in question, how much is actually used, run the CSMD for any abuse pattern and a copy of the report is logged into the chart.  This CSMD report is something we’ve been doing for many years so I do not see any problems or issues for our patients.  The major difference is now it’s the law. Prescriptions will be for one month supply and if appropriate can have 2 additional refills for a total of 90 days supply.  

While this only affects a minority of our patients, it’s a significant change that are affected.  We promise to do the best we can with the situation for all involved.