[Health&Healing] Medicare By Lottery

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Misty L. Trepke

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Medicare by Lottery

 

http://www.nytimes.com/2004/06/25/politics/25drug.html?

th= & pagewanted=print & position=June

25, 2004Lottery Planned for Test of Medicare's New Drug CoverageBy

ROBERT PEAR

 

ASHINGTON, June 24 - The Bush administration announced Thursday that

it would conduct a lottery to select 50,000 people who will receive

Medicare coverage of prescription drugs in the next 18 months,

before drug coverage becomes available to all Medicare beneficiaries

in 2006.

 

The lottery is part of an unusual experiment to test the new benefit

among people with cancer, rheumatoid arthritis, osteoporosis,

multiple sclerosis and a few other diseases.

 

In authorizing the experiment, Congress provided $500 million. Forty

percent of the money, or $200 million, is earmarked for oral cancer

drugs that patients can take on their own, as a replacement for

drugs they receive by injection or infusion in a doctor's office.

 

Tommy G. Thompson, the secretary of health and human services, said

that 500,000 to 600,000 people might be eligible to compete for the

50,000 slots.

 

The government, Mr. Thompson said, will select participants at

random from the pool of applicants, alternating between cancer

patients and those with other serious diseases.

 

" Through this coverage, " he said, " seniors will save thousands of

dollars on essential medicines that they can take at home. "

Moreover, he said, all applicants who meet the eligibility

criteria " will have an equal chance to get into the demonstration "

if they apply by Sept. 30.

 

The new project offers a preview of the drug benefit that will be

offered in 2006 to all 41 million elderly and disabled people on

Medicare.

 

Beneficiaries will generally have to pay the same share of drug

costs in the demonstration project as in the standard Medicare drug

coverage that begins in 2006. They will also face a large gap in

coverage, like the " doughnut hole " in the standard Medicare drug

benefit. But under both programs, co-payments will be reduced or

eliminated for low-income people.

 

Medicare will cover 26 drug products including tamoxifen, for breast

cancer; Gleevec, for types of lymphoma and gastrointestinal tumors;

thalidomide, for multiple myeloma; Iressa, for lung cancer; Enbrel

and Humira, for rheumatoid arthritis; and Avonex and Betaseron, for

multiple sclerosis.

 

For people with multiple sclerosis or rheumatoid arthritis, Mr.

Thompson said, the new program could reduce costs by 75 percent, to

about $4,000 a year, from about $16,000. For a person with an annual

income less than $12,600 (35 percent above the poverty level), he

said, the cost will be no more than $60 a year for any drug in the

demonstration program.

 

Patients and their advocates welcomed the initiative and promised to

publicize it.

 

" It appears that 25,000 cancer patients will benefit from this

program and gain coverage for life-saving medications, " said Wendy

K. D. Selig, vice president of the American Cancer

Society. " Coverage for oral cancer drugs was a huge priority for us. "

 

People are ineligible for the project if they have comprehensive

drug coverage from another source like Medicaid or an employer-

sponsored health plan or Tricare, the military health care program.

 

Senators Olympia J. Snowe, Republican of Maine, and John D.

Rockefeller IV, Democrat of West Virginia, hailed the initiative,

which is modeled on legislation they introduced in 2001, along with

Representative Deborah Pryce, Republican of Ohio.

 

" Increasingly, " Ms. Snowe said, " new cancer drugs are available in

an oral form, " and patients battling cancer should not have to make

unnecessary trips to the doctor's office to receive treatments.

 

The new Medicare law, which President Bush signed Dec. 8, called for

the demonstration project. Mr. Rockefeller said he wished the

administration had started the project in early March, as the law

envisioned.

 

Under the demonstration program, Medicare will also cover certain

drugs for ovarian cancer (Hexalen), hepatitis C (Pegasys and PEG-

Intron) and a bone disorder known as Paget's disease (Fosamax).

 

Federal officials said the new initiative would be run by

TrailBlazer Health Enterprises, a subsidiary of the Blue Cross and

Blue Shield plan in South Carolina, under a federal contract for

$8.7 million. The drug benefit will be administered by Caremark, one

of the nation's largest pharmacy benefit managers.

 

In the past, some Medicare officials said they did not want to pay

for unapproved uses of certain expensive cancer drugs, even though

cancer specialists frequently prescribe such " off-label " uses. Ms.

Selig said she was pleased to see that the Medicare demonstration

program would pay for thalidomide to treat multiple myeloma, a use

that she said had not been explicitly approved by the Food and Drug

Administration.

 

" More than half of all cancer patients receive at least one drug for

an off-label indication, " Ms. Selig said, adding that the precedents

set in the demonstration program would be important for Medicare in

the future.