Drug plans deny certain antidepressants, antipsychotics to residents, pharmacists say
The new Medicare drug benefit has affected medication access for about 1 million nursing home residents, pharmacists say.Some plans are not paying for injectable medications to treat infections or intravenous solutions to hydrate residents, according to pharmacists. In response, the Centers for Medicare & Medicaid Services held a two-hour conference call with drug plans and pharmacists Tuesday to clarify issues related to coverage of injectable drugs and intravenous solutions.
In another problem area, plans are declining to cover prescriptions for antidepressants such as Lexapro, a newer antidepressant, without prior approval. Such action concerns pharmacists because changing medications can be risky for older people. Also, many residents find Lexapro works best for them.
Other drug plans are requiring the use of older-generation anti-psychotic medications for residents even though newer drugs often have fewer side effects. Plans are offering Haldol as an alternative to newer anti-psychotics such as Risperdal or Zyprexa. Some Medicare plans will allow residents to get the newer medications only if they first try a lower-cost alternative.
This "step therapy" requirement was supposed to be waived during the first several months of the Medicare drug program.