MEDICARE BENEFICIARIES BEGIN RECEIVING SAVINGS ON DRUG COVERAGE FOR SERIOUS DISEASES
Medicare beneficiaries with serious diseases who enrolled early in a new large-scale demonstration program are saving up to 90 percent on the cost of oral and self-injectable drugs that replace drugs previously only delivered in physician offices, Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare & Medicaid Services (CMS) announced today.
“Medicare beneficiaries with serious illnesses are saving up to 90 percent on the cost of life-saving and life-enhancing drugs that can be taken in their homes. ” McClellan said. “If you’re living with one of these serious illnesses and have to pay on your own for these critical modern medicines, we encourage you to enroll. Help is simply a phone call, or Internet click, away.”
McClellan said nearly 4,000 Medicare beneficiaries who applied for early enrollment in the Medicare Replacement Drug Demonstration are currently receiving coverage.
Helen Curtis, a Medicare beneficiary, who lives in Scarsdale, NY, says she expects to save $12,000 to $14,000 through the rest of 2004 and 2005 on her prescriptions for Humera, a drug for treatment of her rheumatoid arthritis.
“That’s a lot of money,” Curtis said. “I can practically live on that. It would buy my food for a year.”
“The patients in this country are well-served with the opportunity that CMS has made available through this program,” said Nancy Davenport-Ennis, CEO of the National Patient Advocate Foundation. “Enrollment relieves them of the financial burden to pay for drugs for which there was no covered benefit previously available. Our companion organization Patient Advocate Foundation is working daily to aggressively assist seniors in the enrollment process for this Demonstration Project and to reach out to our non-profit colleagues, physicians and patients to inform them of this opportunity.”
Beneficiaries with cancer, multiple sclerosis, rheumatoid arthritis, and other serious diseases who applied by August 16 began receiving benefits on Sept. 1. The next enrollment period ends September 30, and those who apply by then and are enrolled will begin receiving benefits by October 18.
The demonstration program is intended to provide beneficiaries without drug coverage savings for certain drugs that are covered by Medicare Part B but until now were only available through the doctor's office. With this demonstration program, the drugs are available orally or through self-injection, which saves money and for many is more convenient.
The savings in drug costs for participants in the Medicare Replacement Drug Demonstration are large -- up to 90 percent in some cases -- on the medicines they take for serious diseases, including cancer, multiple sclerosis and rheumatoid arthritis. For example:
- A patient with Chronic Myelogenous Lymphoma using the drug Gleevec could save 78 percent of a cost that might reach $19,000.
- Also, equally large savings will be available for other disease and drugs. For example, patients with Multiple Sclerosis using drugs for that condition may save 71 percent of the cost.
In addition to savings under this program, participants may also be eligible for manufacturer programs and state prescription assistance programs that may also provide assistance with drug costs for some patients.
Also, just like the Medicare drug benefit, the demonstration benefit allows beneficiaries with limited means (incomes below 135 percent of poverty) to reduce their costs for the drugs included in the demonstration to $5 per prescription or less. Beneficiaries with incomes below 15 percent of the federal poverty level and limited assets also qualify for additional assistance.
In addition, the program will also help Medicare learn about the impact of drug coverage coming in 2006 for all beneficiaries on the use and cost of physician-administered drugs currently covered in Medicare Part B.
Under the demonstration, as established under the Medicare Modernization Act (MMA), Medicare will pay for certain drugs and biologicals that can be taken by the patient at home. Because these drugs will be included in the new Medicare drug benefit in 2006, the demonstration study provides an opportunity for Medicare to learn about the impact of the new drug coverage on the use of oral drugs that can “replace” currently covered Part B drugs.
These medicines replace drugs that are currently covered under Medicare Part B when administered in a doctor’s office. Newer, more effective medications that replace some currently covered oral anti-cancer drugs also will be covered. So far, more than 25 drugs are covered under the demonstration.
Three-fourths of Medicare beneficiaries have drug coverage now and some beneficiaries get assistance through manufacturer and other assistance programs. The program is intended for beneficiaries with limited outpatient drug coverage without or without Medicare or access to drug assistance programs, who consequently may have to use Part B drugs even if they would prefer the convenience of drugs they can take at home.
As set by Congress, enrollment in the demonstration will be open to as many as 50,000 people, and total spending on the covered drugs cannot exceed $500 million. If Medicare should receive more than applications than can be enrolled within these limits, participants will be chosen by random selection.
If Medicare does not receive more applications by September 30, 2004 than it can fill within the statutory limits, then all eligible applicants will be accepted. CMS will continue to accept applications after September 30 on a rolling basis until one of the statutory limits is reached.
Information about the demonstration, including the complete list of covered drugs, brochures, and application forms, may be downloaded from the CMS Web site at http://www.cms.hhs.gov/researchers/demos/drugcoveragedemo.asp. Customer service representatives are available at 1-866-563-5386, or by TTY at 1-866-536-5387, to answer questions about the demonstration and assist beneficiaries in obtaining and completing the application forms.