Medicare lottery will give drug coverage to 50,000

Friday, June 25, 2004

WASHINGTON -- Medicare is planning a lottery later this year for people with cancer, multiple sclerosis and several other diseases. For the 50,000 winners, the government will start helping pay for their medicine, but more than 450,000 others must wait until 2006.

Congress wrote the program into last year's Medicare prescription drug law to give a head start to people who take oral cancer drugs that can cost tens of thousands of dollars a year. Treatments for MS, rheumatoid arthritis and six other illnesses that can be administered at home also will be covered, the Bush administration announced Thursday. Similar drugs often are paid for when dispensed in doctors' offices and hospitals.

"This initiative will get these breakthrough oral medications into the hands of seniors fighting cancer so that they have the best opportunity possible to beat the disease," said Rep. Deborah Pryce, R-Ohio, whose daughter died of cancer. She wrote the provision, along with Sen. Olympia Snowe, R-Maine.

However, the law limits the new program to 50,000 people and $500 million, at least $200 million of which must be spent on cancer drugs. Health and Human Services Secretary Tommy Thompson estimated 500,000 to 600,000 Medicare recipients without prescription drug coverage are eligible.

"There'll be a lottery to be chosen as one of 50,000 lucky individuals," Thompson said.

Wendy Selig, vice president for legislative affairs for the American Cancer Society, said some coverage is better than none. "It's clearly not going to meet the needs of every person who may be eligible. Then again, Congress didn't give them the authority to go out and do that so we can't hold them responsible," she said, referring to Medicare.

The American Society for Clinical Oncology, an organization of cancer doctors, has said that because of the limits, the program "will have a minimal impact on people with cancer" until 2006.

Broad prescription drug coverage for older and disabled Americans will begin in 2006 under Medicare.

The new law, thought to be an election-year boon for the GOP, actually has been a thorn. Allegations of ethical improprieties in the law's passage, and a slow, confusing start to the Medicare-approved discount drug cards have plagued the Bush administration and congressional Republicans.

Pryce and two other Republican lawmakers joined Thompson and Medicare chief Mark McClellan to announce the start of the new program. Thompson said it offered a taste of the savings that will be available in 2006.

Medicare will accept applications for the lottery from July 6 to Sept. 30, and will randomly select 25,000 cancer patients and 25,000 people with the other illnesses.

People who apply by Aug. 16 will be eligible for an early draw, with coverage beginning Sept. 1.

The government is paying Trailblazer Health Enterprises, a subsidiary of Blue Cross Blue Shield of South Carolina, $8.7 million to run the program, Medicare officials said.

Among the cancer drugs covered are Gleevec for stomach cancer, thalidomide for blood cancer and tamoxifen for breast cancer. The new cancer drugs are increasingly available only in oral form. Medicare has long paid for chemotherapy and other cancer treatments administered in hospitals and doctors' offices.

The program will mirror the 2006 drug benefit, meaning that there will be a gap in coverage -- known as a doughnut hole -- in which patients will bear the entire cost of the medicines. People still will have to spend about $5,300 a year for Gleevec, but that represents nearly 90 percent off the annual average wholesale price of $45,952, Medicare said.

"Only a cynical pessimist can look at a doughnut and complain about the hole," Thompson said.


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