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Medicare Settles Suit Over Failure to Cover Eye Medication
- June 2nd, 2003
In August 2002, ElderLawAnswers reported that three Medicare beneficiaries had sued the Bush administration because they were denied coverage for treatment of a disease that causes blindness. (See "Medicare Sued Over Failure to Set Up Appeals Process".)
The three beneficiaries suffer from a form of macular degeneration that causes occult eye lesions and can lead to blindness. The beneficiaries claimed that the only effective treatment for the disease is a drug called Visudyne. CMS initially announced that Medicare would cover the drug for this use, but in March 2002 it reversed its decision, saying the treatment is "experimental" and only "temporarily" effective. Medicare covers Visudyne to treat a different form macular degeneration.
When the three plaintiffs tried to appeal the reversal, they received word from CMS that their appeals would not be processed. This, they claimed in their suit, violates a law passed by Congress in December 2000 that required CMS to create an appeals process for national coverage decisions. Congress mandated that the appeals process be in place by October 2001.
Under the terms of the settlement, CMS will convene an outside advisory committee to consider whether Medicare should cover Visudyne to treat occult eye lesions, according to the Wall Street Journal. CMS will not have to adhere to the recommendation of the advisory committee.
Local Elder Law Attorneys in Ashburn, VA
Margaret A. O'Reilly, PC
Margaret A. O’Reilly is an estate planning and elder law attorney with over thirty-five years of legal experience. Attorney O’Reilly graduated from Duke University with a degree in psychology, and received her law degree from Northeastern University School of Law in Boston, Massachusetts. For over 15 y...
Hale Ball Carlson Baumgartner Murphy PLC
Jean Galloway Ball is certified in Elder Law by the National Elder Law Foundation. She is a 1977 honors graduate of the National Law Center, George Washington University, and she did her undergraduate work at the University of California at Berkeley, graduating Phi Beta Kappa in 1971. She is admitted to practice in Vir...