AGS BEER’S CRITERIA FOR POTENTIALLY INAPPROPRIATE MEDICATION USE IN OLDER ADULTS

TO: MEDICARE RECIPIENTS

In 2011, the American Geriatrics Society issued a listing of medications that were deemed to be potentially inappropriate for use in older adults usually on the pretense they could cause sedation and increase the risk of falling. Since that time, many Medicare plans have decided to require a prior authorization for the medications that appear on the list. While the decision to prescribe these medication is still a matter between the patient and their physician, but the decision as to rather or not your insurance company will pay for such prescribed medications is not.

Pease Integrative Medicine Office will not pursue prior authorization for these medications any longer. Exceptions will only be made when a provider and patient have an office visit whereat previous drug failures and medical necessity has been thoroughly documented so as to clearly support the need for this specific medication. Documentation of the potential risks associated with the use of such medication will be recorded. However, please be aware that this still will not guarantee that a prior authorization will be approved by your insurance company; it merely is a requirement to initiate the prior authorization process.

Pease Integrative Medicine Office strongly recommends that you visit any of the prescription drug websites (ex. www.rxpricequotes.com) to locate a local pharmacy and the pricing they are offering for your desired medication. You will find, in the majority of these situations, the cash pay cost of the medication is less than $25 for a 90 supply and will cost very little more than obtaining the medication through a prescription plan. You will need to notify the pharmacy that you will not be using your insurance prescription coverage plan and that you are exercising your right to pay cash for your prescription.

View a complete listing of medications found on the Beer’s list. The most commonly prescribed medication we have found that are prescribed from our office that fall under this category are Ambien, benzodiazepines (ex: Xanax, Klonopin, etc.) and estrogens.