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money. Benzodiazepines are central nervous system depressants that are fairly inexpensive. But they're highly addictive, frequently abused and over-prescribed, Beshara said.
"Although we might be different from our colleague states, we are no different from the federal government," Beshara said of Medicare's ban on covering the drugs.
A study by University of Tennessee Health Science Center found that 2.5 percent of TennCare patients, or about 3,843 people, who used the medications in 1999 inappropriately used the drugs.
Asked why the state didn't act sooner on its safety concerns, TennCare spokeswoman Marilyn Elam said the staff has been "consumed with litigation efforts and fighting back a crippling $650 million budget hole."
Experts in geriatric care say the drugs are also problematic for seniors because they can cause drowsiness that could lead to falls and broken hips.
"Quite frankly, I would not give one of these drugs to my mother," Beshara said.
Dr. Richard Stefanacci, executive director of the Health Policy Institute at the University of the Sciences in Philadelphia, agreed that the drugs pose a concern for seniors. But he said that's not a reason to stop covering the drugs for Tennessee's entire adult Medicaid population. For acute seizure and anxiety disorders, benzodiazepines are the medication of choice, he said.
"If clinical situations support their use, you put in safeguards to make sure they're used appropriately," Stefanacci said.
Tennessee's decision to halt the drug coverage has angered the state's 15-member Pharmacy Advisory Board, which recommends the drugs TennCare should cover. The panel wasn't consulted about the change.
"Individually, I can tell you that all members of the committee do not favor this and certainly would never have voted for this if we had known about it," said Dr. James Powers, chairman of the advisory board and a geriatrics specialist at Vanderbilt University Hospital in Nashville.
Beshara said the board's charter doesn't require notification on such coverage changes, but he acknowledged that the panel has had input in similar decisions.
Some people affected by the cuts have relatives who help them purchase their drugs. Others can get them for free through pharmacy assistance programs run by drug companies. But enrollment in those programs isn't assured and there's no guarantee that those offerings will continue.
Rickett, 30, is already struggling under the policy change. He's taken a benzodiazepine, Clorazepate, for about five years to combat depression and muscle spasms associated with his cerebral palsy.
His doctor tried to substitute an antidepressant, Effexor, which was covered under the new Medicare benefit.
"After three days, I was shaking so bad I had to quit taking it," Rickett said. "It actually made things worse."
With his $623-a-month income from Supplemental Security Income and Social Security already spoken for, Rickett can't afford the $64.88 a month it would cost to buy Clorazepate. So he borrows Xanax and other drugs from relatives to tide him over.
Rickett is filing an appeal with his Medicare drug plan for a coverage exception, but he doesn't expect an answer for several weeks. He said that without the medication, he can't continue vocational classes to land a job in Web site design.
"After a few days without it, I start to have problems. Without the drugs, it would be hard for me to go out in public, work or go to school or basically live a normal life," Rickett said.
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To find out whether your state Medicaid program covers the nine categories of drugs that Tennessee has decided not to cover, go to www.cms.hhs.gov/States/EDC/list.asp
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