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Medicare Announces Lottery for Pilot Drug Coverage Program

  • July 2nd, 2004

Beginning this fall, 50,000 Medicare beneficiaries with certain chronic conditions will receive prescription drug coverage for some of their most expensive medications under an 18-month demonstration project.

The pilot project, which was included in the new Medicare law, will provide the same sort of drug coverage that all Medicare beneficiaries will be eligible for beginning in 2006. But the coverage will be limited to 50,000 patients with multiple sclerosis, certain kinds of cancer, rheumatoid arthritis, osteoporosis, pulmonary hypertension, secondary hyperparathyroidism, Paget's Disease, hepatitis C, or CMV retinitis. Participants must lack coverage for drugs that can be administered by the patient him or herself to treat one of these conditions.

The 50,000 enrollees in the demonstration project will be determined by lottery. The Department of Health and Human Services (HHS) estimates that some 500,000 to 600,000 Medicare beneficiaries will be eligible to be one of the 50,000 participants. The Medicare law specifies that 40 percent of the funds for the program be spent on cancer treatment. Beneficiaries' incomes will not be considered for participation in the program, according to officials.

Like the Medicare prescription drug benefit that goes online in 2006, the program will include a $250 annual deductible and copayments. Beneficiaries will be responsible for all drug costs between about $660 and $1,200. Low-income beneficiaries who participate in the project will receive extra help from the federal government and will pay no more than $60 per year for any drug covered under the program, according to HHS.

The Center for Medicare Advocacy advises that "Everyone with multiple sclerosis, certain kinds of cancer, rheumatoid arthritis, osteoporosis, pulmonary hypertension, secondary hyperparathyroidism, Paget's Disease, hepatitis C, or CMV retinitis who doesn't have insurance to pay for their prescriptions should apply for the demonstration project, even though the chances of being selected may be minimal."

Beneficiaries who wish to participate can apply between July 6 and September 30 on www.medicare.gov or by calling 1-800-MEDICARE. Starting July 6, Trailblazer Health Enterprises, the Medicare contractor that will administer the demonstration project, will operate a call center to provide information about the demonstration. The contact number is 866-563-5386, or 866056305387 (TTY). Coverage could begin as soon as September 1 for patients who apply by August 16.

For more details on the program from the Center for Medicare Advocacy, click here.

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Last Modified: 07/02/2004

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