Medicare Part D Exclusion of Benzodiazepines and Fracture Risk in Nursing Homes

Following the enactment of Medicare Part D, Tennessee was the only state to forgo supplemental coverage for benzodiazepines; when benzodiazepine prescriptions declined, nursing home residents in Tennessee experienced more falls and hip fractures.Benzodiazepines are controversial sedatives. Enacted in 2006, Medicare Part D excluded reimbursements for benzodiazepines. However, most state Medicaid programs continued to provide supplemental coverage for benzodiazepines.

This article reports on a longitudinal study that examined benzodiazepine use before and after Medicare Part D. The aim of the study was to determine how different state policies limiting benzodiazepine use influenced benzodiazepine prescribing. In addition, the study investigated whether fluctuations in benzodiazepine prescribing affected the number of falls and hip fractures.

The authors analyzed drug prescribing data and records of falls and hip fractures for nearly half the entire U.S. Medicare population. Interrupted times-series estimation focused on three basic terms: monthly prescription changes prior to Medicare Part D, estimated changes in the first month after the policy, and relative trends before and after Medicare Part D. Data on falls and fractures came from the Minimum Data Set, a health assessment tool.

Key Findings:

  • In Tennessee, immediately following Medicare Part D, there was a significant decrease in the percentage of nursing home residents receiving benzodiazepines.
  • The rate of hip fractures almost doubled (6.4%-12.4%) from 2005 to 2006 (i.e., before and after Medicare Part D) in Tennessee.

This article reports on benzodiazepine prescribing and falls and fractures in nursing homes before and after Medicare Part D.