New Medicare Demonstration Program Will Provide Coverage of Certain Drugs

Medicare has announced the implementation of a new demonstration program that will provide transitional coverage for certain oral drugs, including certain oral anticancer drugs, until the full Medicare prescription drug benefit is implemented in 2006. Many ASH members may find this useful information to share with their patients to help them achieve greater access to expensive medications.

The demonstration program, known as the Medicare Replacement Drug Demonstration, will be open to 50,000 patients, and total spending on the covered drugs will be up to $500 million. Applications will be accepted between July 6 and September 1, 2004. Under this program, Medicare will pay for certain drugs and biologicals that can be taken by the patient to replace drugs which are currently covered under Medicare Part B when given in a doctor’s office. Several anticancer drugs are included in the demonstration.

The demonstration program will provide accepted Medicare beneficiaries significant savings on their eligible medications. For example, Medicare estimates that for patients with chronic myelogenous leukemia*, Gleevec has an annual cost of $45,952, but patients in the demonstration program would only pay $5,298.

Below is a link to the Medicare Web site that provides additional information about this program. In addition, we have included a link to the program application, which must be signed by the prescribing physician.

Medicare Replacement Drug Demonstration Program Information

Application for Medicare Replacement Drug Demonstration

A Special Edition Medlearn Matters article concerning the Medicare Replacement Drug Demonstration (MRDD) (MMA Section 641) is now available at: www.cms.hhs.gov/medlearn/matters/mmarticles/2004/SE0443.pdf.

For more information, please contact Jody Blatt at the Centers for Medicare & Medicaid Services at 410-786-6921 or jblatt@cms.hhs.gov.

*Please note: Materials on the Medicare Web site incorrectly refer to “chronic myelogenous lymphoma” as a demonstration-covered indication. Medicare is aware of this error and is in the process of updating all materials to refer to “chronic myelogenous leukemia.”