NCI Cancer Bulletin: A Trusted Source for Cancer Research NewsNCI Cancer Bulletin: A Trusted Source for Cancer Research News
July 6, 2004 • Volume 1 / Number 27 E-Mail This Document  |  Download PDF  |  Bulletin Archive/Search  |  Subscribe

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HHS News

Medicare Prescription Drug Coverage Pilot Includes
Oral Cancer Drugs

Up to 50,000 Medicare patients will participate in a demonstration project that provides prescription drug coverage, including coverage of 12 oral anticancer drugs, U.S. Department of Health and Human Services Secretary Tommy Thompson announced on June 24. Under the Medicare Replacement Drug Demonstration program, Medicare will cover prescription drugs for several serious diseases and life-threatening conditions. The program will initially be open to 50,000 current Medicare beneficiaries. It will allow for the spending of $500 million on covered drugs, before the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) comes into effect in 2006.

A full 40 percent of the total funding will be earmarked for oral cancer drugs that patients can take at home. The remaining 60 percent will be allocated for drugs for other debilitating conditions, such as multiple sclerosis and rheumatoid arthritis. In this preview of MMA, beneficiary co-payment and cost sharing will mirror what will be the standard Medicare Part D prescription drug benefit in 2006, but will operate without the monthly premium that will eventually be paid by patients.

Under the pilot, Medicare will cover 26 drugs, including prominent cancer therapies such as tamoxifen for breast cancer, imatinib (Gleevec) for chronic myelogenous leukemia and gastrointestinal stromal tumors, thalidomide for multiple myeloma, and gefitinib (Iressa) for lung cancer. A full list of the covered drugs is available at http://www.cms.hhs.gov/researchers/demos/MMAExternalQsAs_6_23_04.pdf.

"The potential to increase the availability of many of the new, orally active cancer therapies is likely to be of major benefit to a significant number of cancer patients who receive Medicare benefits," said Dr. James H. Doroshow, director of NCI's Division of Cancer Treatment and Diagnosis. Cost savings to beneficiaries could range from 75 to 90 percent, depending on the drug and financial situation of the participant.

To be eligible for the demonstration, beneficiaries

  • Must be currently enrolled in Medicare Part A and Part B;
  • Must indicate Medicare as their primary payer and may not have comprehensive drug coverage through other sources; and
  • Must provide a signed certificate from a doctor that they require one of the drugs covered under the plan for an indicated disease.

Applications may be submitted from July 6 to Sept. 30, 2004, and can be downloaded at http://www.cms.hhs.gov/researchers/demos/drugcoveragedemo.asp. For more information, call 1-866-563-5386, TTY 1-866-563-5387.