Deadline approaches to apply to Medicare program for self-injected biologics to treat RA

[Guest guest]

Arthritis Foundation

Advocacy News

Reminder: Deadline approaches to apply to Medicare program for

self-injected biologics to treat rheumatoid arthritis.

What biologics are covered: Enbrel, Humira, and Kineret for the

treatment of rheumatoid arthritis

Who is eligible:

Beneficiaries 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 covered drugs

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.

How will applicants be chosen?

Enrollment is limited and participants will be chosen on a random basis

among all completed applications received.

Completed applications submitted by August 16, 2004, may be part of an

early selection process. This means your coverage could begin September

1, 2004.

Applications must be received by September 30, 2004. Applications

received after that date will only be considered if space is still

available. Applicants will be notified in writing of their status

regarding participation in the demonstration.

How do beneficiaries apply?

Applications are on the web site at

http://www.arthritis.org/advocacy/Medicare_Demo_Project_Enrollment.asp,

or call 1-866-563-5386. TTY users should call 1-866-563-5387. Customer

Service Representatives are available between 8:00 a.m. and 7:30 p.m.

Eastern Time Monday through Friday.

What is the cost to the beneficiary?

Patients with rheumatoid arthritis could save 75 percent or $11,975

annually off medicines that cost an estimated $16,000. Low-income

beneficiaries in the demonstration would save significantly more. For

those between 135 and 150 percent of the federal poverty level,

rheumatoid arthritis patients would pay an estimated $628. For those

between 100 and 135 percent of the federal poverty level, they would pay

at most $60 per year.

What is the duration?

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.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org