50,000 people in the U.S. with cancer, multiple sclerosis, rheumatoid arthritis or hepatitis C will be eligible for a Medicare drug lottery

50,000 people or 10% of the 500,000 people in the U.S with cancer, multiple sclerosis, rheumatoid arthritis or hepatitis C will be eligible for a Medicare drug lottery for coverage of life saving drugs.

The Centers for Medicare and Medicaid Services is using the lottery process to select these patients to receive the drug coverage more than a year before it becomes available to all Medicare beneficiaries in January, 2006.

The lottery will take place in late 2004 with government commencing payments for therapies for the 50,000 winners.

The lottery is being touted as a demonstration program for the Medicare reform law passed last year.

To qualify for the lottery, you must meet the following requirements:

  • You must have Medicare Part A and Part B
  • Medicare must pay first for your health care services (called the primary payer)
  • You must have a signed document from your doctor stating that you need one of the drugs covered under this program for the specific covered condition
  • You don’t have comprehensive outpatient prescription drug coverage from any other insurance (other than a Medicare Advantage plan or Medigap policy), including Medicaid, TRICARE, or an employer or union group health plan or other source of comprehensive coverage for these drugs
  • You live in one of the 50 states or the District of Columbia

You can send in your application anytime after July 6, 2004. Applications must be received by September 30, 2004.

Medicare Replacement Drug Demonstration – Annual Beneficiary Costs

Disease Compound Name (Brand Name) Estimated Annual Retail Cost (1) Estimated Cost under Standard Cost Sharing (2) Savings (Percent) Estimated Cost under Low Income Subsidy (135-150% of FPL) (3) Savings (Percent) Estimated Cost under Low Income Subsidy (100-135% of FPL) (4) Savings (Percent)
Cutaneous T Cell Lymphoma Bexarotene (Targretin) $61,320 $5,951 $55,369 (90%) $643 $60,677 (99%) $60 $61,260 (100%)
Gastrointestinal Stromal Tumor Imatinib Mesylate (Gleevec) $45,952 $5,298 $40,654 (88%) $638 $45,314 (99%) $60 $45,892 (100%)
Chronic Myelogenous Lymphoma Imatinib Mesylate (Gleevec) $45,952 $5,298 $40,654 (88%) $638 $45,314 (99%) $60 $45,892 (100%)
Anaplastic astrocytoma Temozolomide (Temodar) $27,878 $4,530 $23,348 (84%) $638 $27,240 (98%) $60 $27,818 (100%)
Epithelial Ovarian Cancer Altretamine (Hexalen) $25,631 $4,434 $21,197 (83%) $638 $24,993 (98%) $60 $25,571 (100%)
Multiple Myeloma Thalidomide (Thalomid) $24,098 $4,369 $19,729 (82%) $633 $23,465 (97%) $60 $24,038 (100%)
Lung Cancer (non-small cell) Gefitinib (Iressa) (5) $3,500 $1,475 $2,025 (58%) $489 $3,011 (86%) $60 $3,440 (98%)
Breast Cancer Stages 2-4 Letrozole (Femara) $2,843 $917 $1,926 (68%) $405 $2,438 (86%) $60 $2,783 (98%)
- Exemestane (Aromasin) $2,827 $903 $1,924 (68%) $403 $2,424 (86%) $60 $2,767 (98%)
- Anastrozole (Arimidex) $2,700 $795 $1,905 (71%) $387 $2,313 (86%) $60 $2,640 (98%)
- Tamoxifen (Nolvadex) $1,642 $536 $1,106 (67%) $252 $1,390 (85%) $60 $1,582 (96%)
- Toremifene (Fareston) $1,411 $487 $924 (65%) $222 $1,189 (84%) $60 $1,351 (96%)
Non-Cancer Diseases
Pulmonary Hypertension Bosentan (Tracleer) $36,136 $4,881 $31,255 (86%) $638 $35,498 (98%) $60 $36,076 (100%)
CMV Retinitis Valcyte (Valganciclovir) $22,911 $4,319 $18,592 (81%) $633 $22,278 (97%) $60 $22,851 (100%)
Hepatitis C Pegylated interferon alfa-2a (Pegasys, PEG-Intron) $17,600 $4,093 $13,507 (77%) $633 $16,967 (96%) $60 $17,540 (100%)
Multiple Sclerosis Interferon beta-1a (Avonex, Rebif), Interferon beta-1b (Betaseron) Glatiramer acetate (Copaxone) $16,298 $4,038 $12,260 (75%) $628 $15,670 (96%) $60 $16,238 (100%)
Rheumatoid Arthritis Anakinra (Kineret), Adalimumab (Humira), Etanercept (Enbrel) $16,000 $4,025 $11,975 (75%) $628 $15,372 (96%) $60 $15,940 (100%)
Paget’s Disease Risedronate (Actonel) $2,700 $795 $1,905 (71%) $387 $2,313 (86%) $60 $2,640 (98%)
Secondary Hyperparthyroidism Doxercalciferol (Hectoral) $2,204 $656 $1,548 (70%) $324 $1,880 (85%) $60 $2,144 (97%)
Paget’s Disease Alendronate (Fosamax) $940 $387 $553 (59%) $162 $778 (83%) $60 $880 (94%)
Osteoporosis (patient must be homebound) Calcitonen-nasal (Miacalcin-nasal) $778 $353 $425 (55%) $142 $636 (82%) $60 $718 (92%)
  1. Estimate based on 100% of Average Wholesale Price (AWP) from March 2004 Redbook for a typical dosage; Actual retail price for a beneficiary may be more or less.
  2. Program cost estimated at 85% of AWP. Retail dispensing fee of $1.50 not included.
  3. Reduced deductible and coinsurance if income between 135 and 150 percent of poverty level.
  4. Flat per-prescription payment if income between 100 and 135 percent of poverty level.
  5. Cost estimated for 3-month course of treatment.

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