Two more drugs added to Medicare demonstration program

Aug 17 2004

The Centers for Medicare & Medicaid Services has announced it is adding two more drugs to the list of drugs covered under a Medicare demonstration program providing substantial savings to beneficiaries with serious diseases, including cancer, multiple sclerosis, and rheumatoid arthritis.

Mark B. McClellan, M.D., Ph.D., CMS administrator, also urged beneficiaries without drug coverage who wish to receive their medicines at home to apply for the program – which provides savings of up to 90 percent, or many thousands of dollars, in many cases – as soon as possible. He noted that beneficiaries have a good likelihood for selection, and then can get the care they need at home within a few weeks of enrolling.

“There are plenty of slots still available to bring life-enhancing, even life-saving drugs to Medicare beneficiaries with these serious illnesses,” McClellan said. “We encourage people without coverage for the drugs they need to sign up, and it’s easy to do so. Help is just a phone call away.”

The new drugs added to the program today are Somavert for treatment of acromegaly; and Mesnex tablets, used to prevent some side effects in patients undergoing certain kinds of chemotherapy. Somavert is a replacement for Sandostatin, a Medicare Part B covered drug. Mesnex tablets are a replacement for intravenous Mesnex.

“This will provide additional access and affordability to vital medicines for people fighting serious disease,” said Health and Human Services Secretary Tommy G. Thompson.

Under the Medicare Replacement Drug Demonstration, 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 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 20 drugs are covered.

The demonstration program is primarily intended for Medicare beneficiaries with limited or no drug coverage who prefer to replace the Part B drugs they currently use with treatments available under the demonstration program. While three-fourths of Medicare beneficiaries have drug coverage now and some beneficiaries get assistance through manufacturer and other assistance programs, beneficiaries without coverage may have to use Part B drugs even if they would prefer the convenience of drugs they can take at home.

In addition to providing major savings, the demonstration program will not make participants ineligible for other 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.

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 and there will be no random selection. CMS will continue to accept applications after September 30, 2004 on a rolling basis until one of the statutory limits is reached.

Beneficiaries who get their applications in by Aug. 16 will be in an “early selection” process that will give them coverage by Sept. 1. Those who apply before Sept. 30 and are accepted will begin getting benefits by Oct. 18.

“People should be signing up now,” McClellan said. “If they need help, there is a toll-free number to call and operators will help them fill out the applications over the phone.”

Savings under the program can be quite large, making it especially important that Medicare beneficiaries who are eligible sign up. For example, some patients with chronic myelogenous lymphoma using the drug Gleevec could save nearly 90 percent, an estimated $40,654, a year. Some patients with pulmonary hypertension using the drug Tracleer would save an estimated 86 percent, or $31,255, annually. Some patients with multiple sclerosis could save 75 percent, or $12,260, on medicines that cost an estimated $16,298 a year. Some patients with rheumatoid arthritis could save 75 percent, or $11,975, on medicines that cost an estimated $16,000 annually.