Medicare Coverage from

Some Self-injected Drugs

 

In recent years, a number of new biological therapies for arthritis and related diseases have been introduced. These treatments often deliver significant relief and can prevent the destructive progression of rheumatoid arthritis. However, the lack of coverage for self-injected biological therapies under Medicare has limited the ability of many individuals to obtain these improved outcomes. Under Medicare, only versions of these therapies administered in a physician’s office or hospital setting are currently covered.

The Centers for Medicare and Medicaid Services (CMS) has launched a drug replacement demonstration project for self-injected biologic drugs, including those used for the treatment of rheumatoid and psoriatic arthritis. The project covers the drugs Enbrel, Humira and Kineret. It is a prelude to the more comprehensive prescription drug benefit which will begin in 2006.

In order to be eligible: Beneficiaries must have Medicare Part A and Part B, Medicare must be a patient’s primary payer, Participants must have a signed document from their physician stating the need for the medication, Participants must not have comprehensive outpatient prescription drug coverage from any other insurance other than a Medicare Advantage or Medigap policy.

The demonstration will run through December 31, 2005. In 2006 beneficiaries must enroll in the Medicare Part D drug benefit in order to continue to receive Medicare coverage for these drugs. For more information call 866-563-5386. You can also learn more on the Arthritis Foundation’s website at www.arthritis.org.

-From: “Health on the Hill”, Publication of MA Representative Peter Ketoujian’s Office, April 7, 2005 Vol. III, No. 7

04/2005