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Medicare to Extend Access to Certain Drugs for Beneficiaries with Serious and Chronic Illnesses

Armen Hareyan's picture

HHS Secretary Tommy G. Thompson announced Thursday a new Medicare demonstration program that will save seniors and persons with disabilities substantial money -- up to 90 percent in some cases -- on the life-enhancing medicines they take for serious diseases, including cancer, multiple sclerosis and rheumatoid arthritis.

The demonstration program, created as part of the Medicare Modernization Act, will extend Medicare coverage to prescription medicines that can be self-administered rather than administered by a health care provider. The demonstration will help up to 50,000 beneficiaries with serious illnesses who do not have comprehensive prescription drug coverage. Total spending on the covered drugs will be up to $500 million and approximately 40 percent of the funding will be allocated for oral anti-cancer medications.

"This demonstration will provide access and affordability to life-saving medicines for people fighting serious diseases," Secretary Thompson said. Through this coverage, seniors will save thousands of dollars on essential medicines that they can take at home. It will relieve some of the burden of battling a debilitating disease.

Under this initiative, Medicare will pay for certain drugs and biologicals that can be taken by the patient at home and that replace drugs which are currently covered under Medicare Part B when given in a doctor's office. The drugs were selected based on criteria developed after extensive input from physicians and other experts. In addition, newer, more effective medications that replace some currently covered oral anti-cancer drugs will also be covered.

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"In some cases, by avoiding the need for doctor visits and intravenous injections, costs and medical complications may be reduced and access and ease of treatment will increase," Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare & Medicaid Services (CMS) said. "And many beneficiaries will get literally tens of thousands of dollars worth of help in purchasing these critical medicines right away, ahead of the Medicare drug benefit in 2006."

The demonstration runs through December 31, 2005 and will give Medicare beneficiaries a glimpse of the significant savings coming their way when the Part D prescription drug benefit is fully implemented in 2006.

Starting immediately, applications may be downloaded from the CMS Web site at http://www.cms.hhs.gov/researchers/demos/drugcoveragedemo.asp

Starting July 6, customer service representatives will be available at 1-866-563-5386, TTY Number: 1-866-536-5387 to answer questions about the demonstration and assist beneficiaries in obtaining and completing the application forms. Between now and July 6, beneficiaries who have questions can call 1-800 MEDICARE. Applications will be accepted for consideration beginning July 6 through Sept. 30.

For examples of estimated savings, applications and eligibility information, please go to: http://www.hhs.gov/news/press/2004pres/20040624.html