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Medicare Patients can Save $ on Gleevec, Humira and other Medications

Medicare currently is conducting a demonstration program that pays for 95% of drug coverage (after limited out-of-pocket costs) for certain diseases including rheumatoid arthritis. CMS is actively educating Medicare beneficiaries about this and is relying on physicians being aware and supportive, as well.

To be eligible, Medicare patients have to be on both Part A and Part B Medicare (as primary), without other drug coverage (Medigap or Medicare managed care OK), and a have covered diagnosis: rheumatoid arthritis for the drugs Humira, Kineret, and Enbrel, osteoporosis (and homebound) for Calcitonin or Miacalcin, among others.

The structure of the demonstration benefit is similar to that of the 2006 Medicare Drug benefit - meaning that there are some out of pocket costs - with catastrophic coverage paying for 95% of the costs of these drugs after the out-of-pocket is met. There are no monthly premiums in the demonstration project, which lasts from now through December 2005.

Coverage can begin this year, but only if your patients apply and qualify! They can call 1-800 Medicare for more information or 866-563-5386 to Trailblazer, the contractor who will assist in filling out the form.

The drugs covered under the demo are self-administrable and replace drugs that are covered under part B and administered in a physician office. Also, this is not the drug discount card, but what was initially was referred to as the Medicare 'lottery'. (There are 45,000 slots available, so eligible applicants are very likely to be accepted.)

For more information go to: http://www.medicare.gov, click on: Medicare Replacement Drug Demonstration.

Page updated: 9/27/04