Medicare to cover some drugs early

[Mike Bartolatz]

Federal Program to Pay for Drugs for Cancer, Other Chronic Illnesses

By Todd Zwillich
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Thursday, June 24, 2004


June 24, 2004 -- Medicare will give early coverage for drugs used by some beneficiaries with cancer and other chronic illnesses under a pilot project set to begin in September, Bush administration officials announced Thursday.


The pilot project, ordered by Congress as part of the Medicare Modernization Act passed last year, will offer federal coverage for many medications not currently paid for by Medicare.


About 10% of the 500,000 to 600,000 patients who could qualify for the benefit will be chosen by lottery for the program, which is limited by law to 50,000 patients or $500,000 million in spending, officials say.


Secretary of Health and Human Services Tommy G. Thompson says patients are set to save between 55% and 90% on prescription costs from a list of 11 anticancer medications and treatments for nine other diseases. Those with incomes below 150% of the federal poverty level get more savings.


Medicare currently limits most drug coverage to intravenous drugs delivered in doctors' offices. Some anticancer medications taken by mouth are also covered, though today's announcement expands the list and adds several medications that patients can inject or take themselves without seeing a physician.


Same as Medicare Rx Benefit


The program offers identical benefits to the Medicare prescription drug benefit due to go into effect Jan. 1, 2006. Officials say the early start will speed lifesaving treatments to patients before that time and will also allow them to determine whether paying for outpatient drugs saves on doctor visits and hospital costs.


"It's going to save substantial money for seniors suffering from serious diseases," Thompson says. The benefit will "essentially mirror" the Medicare prescription drug benefit.


Drugs covered include Gleevec, used for chronic myeloid leukemia -- a type of cancer of the blood, tamoxifen for breast cancer, and several medications for rheumatoid arthritis. Iressa, an anticancer treatment for patients with non-small cell lung cancer, and several medications used to treat multiple sclerosis are also covered.


According to a breakdown of prices released by the HHS, a patient taking tamoxifen would pay $536 of the drug's normal $1,642 retail price for a one-year supply, a savings of 67%. The out-of-pocket cost includes a $250 deductible and co-payments required under the normal Medicare benefit.


Officials expect Medicare's cost to be about 15% lower than the retail price because a pharmacy benefit management company will negotiate discounts with drug manufacturers, says Medicare director Mark B. McClellan, MD.


Officials say a list of covered drugs and conditions are now available on the agency's web site, www.medicare.gov. Elderly and disabled beneficiaries taking the drugs can begin applying with the agency July 6.


Chosen by Lottery


Officials say they will hold a series of nationwide lotteries to choose eligible seniors beginning Aug. 16. One Medicare official says that income will not be a factor governing who is chosen, though Congress set aside $200 million for anticancer drugs and $300 million for treatments for other illnesses that limit eligibility in each group.


Starting July 6, beneficiaries can also call (866) 563-5386 to enter the lottery.



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SOURCES: Tommy G. Thompson, secretary of Health and Human Services. Mark B, McClellan, MD, Administrator, Centers for Medicare and Medicaid Services.


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