Fwd: MEDICARE REFORM & Rx PRESCRIPTION DRUG COVERAGE

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In a message dated 11/19/2003 5:03:20 PM Eastern Standard Time, federalupdate@... writes:

MEDICARE REFORM & PRESCRIPTION DRUG COVERAGE

On November 16th, congressional leaders announced an "agreement in principle" on major provisions of a Medicare prescription drug bill. President Bush endorsed the compromise and called on members to complete the bill before year end. Most key lawmakers believe the leadership-supported compromise has significantly increased the likelihood of final enactment this year.

Given the cost limit of $400 billion over ten years and widely divergent philosophies concerning Medicare reform, this may be our nation's best chance to add a drug benefit to Medicare. Although the Society has some reservations about pending Medicare legislation, we are encouraged by the recent congressional compromise and consider it a significant step forward. It would be unfortunate to miss this opportunity, and we are committed to working with Congress and our coalition partners to ensure comprehensive, meaningful Medicare legislation is signed into law this year. Transitional Coverage for MS Injectables. MS Society advocates have been working for over 18 months to secure immediate, transitional coverage for all four MS immunomodulating medications under Medicare. Since August of 2002, Medicare only covers one of the four MS injectable therapies, if administered in a physician's office. For a beneficiary who cannot take the covered MS injectable, or cannot receive the injection in a physician's office, Medicare coverage of all four MS therapies in any setting (e.g, at home) is critical.

Language providing transitional Medicare coverage for all four MS injectables in '04 and '05 - until an overall Medicare Rx benefit becomes effective - was included in the Medicare package recently sent to the Congressional Budget Office for a cost estimate. This is a promising sign; however, the prospects for immediate MS-specific coverage remain uncertain. It is unclear how many extra provisions lawmakers will be able to include in the final Medicare package as the entire bill must fit within a ten-year, $400 billion spending limit.

Society advocates nationwide have worked especially hard over the past few months to include MS coverage as part of final legislation. Our sincere thanks to the 37 chapters who helped deliver the MS Society's message to key congressional lawmakers and their aides over the course of the year.

Proposed Overall Rx Benefit. We expect the benefit would help beneficiaries with relatively low drug costs (less than $2,200/year) and high drug costs (over $5,000/year). The basic provisions of the new Medicare "Part D" drug benefit are: coverage begins in 2006, with an average monthly premium of $35, and an annual $275 deductible. Thereafter, Medicare would pay 75% of drug costs up to $2,200. After $2,200 in total drug costs, a gap in coverage would exist until drug costs reach $5,000 (or about $3,600 out of pocket). After this point, Medicare would pay about 95% of subsequent "catastrophic" drug expenses that year.

Low Income Protections. Under the agreement, individuals with incomes below 135% ($12,123/year) of the federal poverty level (FPL) generally would not pay premiums, deductibles or the gap in Rx coverage. Additionally, beneficiaries with incomes between 135% of FPL and 150% ($13,470) of FPL would receive sliding scale Part D premium assistance.

Compromises. The new Medicare agreement strikes a balance on a number of critical issues. For example, the compromise includes up to $70 billion in tax-free subsidies to encourage employers to continue providing drug coverage once the Medicare Rx benefit becomes effective. Also, lawmakers amended a controversial House provision calling for nationwide direct price competition between traditional Medicare and private health plans - known as "premium support." The recent agreement includes a temporary, limited pilot project to test competition in up to six metropolitan areas beginning in 2010. Also, in an effort to provide financial aid to the states, Medicare would pick-up the entire cost of covering all Medicare beneficiaries, including those who are covered under both Medicare and Medicaid ("dual eligibles").

Other Medicare Improvements. The Society also has been engaged on a number of other areas of the Medicare reform legislation. Over the months, we have worked with the Consortium of Citizens with Disabilities and other patient and disability organizations. As we understand it, we have succeeded in persuading legislators to oppose additional home-health co-payments, maintain a fair appeals process and coverage standards, and remove annual $1500 therapy caps on physical, speech, and occupational therapy services.

Overall Medicare Bill Prospects: The final Medicare conference agreement awaits passage by both the House and Senate and signature by President Bush. Prospects for enactment are uncertain at this time because total cost estimates are still in the works and because there is still widespread disagreement about the bill's contents.

For more information on the Society's Medicare principles and coverage of MS therapies: http://www.nationalmssociety.org/medicare_factsheet.asp

FUNDING FOR MS RESEARCH

Lawmakers expect to consider the Labor, HHS, and Education (Labor-HHS) Appropriations bill that provides funding for biomedical research at the National Institutes of Health (NIH) as part of an omnibus appropriations package - possibly before December. Neither the Senate nor the House Labor-HHS bill provided adequate FY'04 NIH funding increases. Following the five-year (FY'99 - FY '03) doubling period, NIH is facing its lowest funding level in years - $27.7 billion from the House and $27.9 billion from the Senate. Overall budget constraints have left congressional conferees with minimal funds for NIH, and many in the research community believe it is likely that conferees will split the difference between the House and Senate figures.

The MS Society has been urging Congress to uphold its commitment to NIH funding and has activated its MS Action Network. Advocates are asked to urge their members of Congress to act now to increase NIH funding.

You still have a chance to increase NIH funding! Take action by visiting the Society's NIH Action Alert at: http://www.nationalmssociety.org/advocacy.asp

Please join the MS Action Network at: http://www.nationalmssociety.org/advocacy.asp to receive Federal Updates and MS Action Alerts via email.

MEDICARE REFORM & PRESCRIPTION DRUG COVERAGE

On November 16th, congressional leaders announced an "agreement in principle" on major provisions of a Medicare prescription drug bill. President Bush endorsed the compromise and called on members to complete the bill before year end. Most key lawmakers believe the leadership-supported compromise has significantly increased the likelihood of final enactment this year.

Given the cost limit of $400 billion over ten years and widely divergent philosophies concerning Medicare reform, this may be our nation's best chance to add a drug benefit to Medicare. Although the Society has some reservations about pending Medicare legislation, we are encouraged by the recent congressional compromise and consider it a significant step forward. It would be unfortunate to miss this opportunity, and we are committed to working with Congress and our coalition partners to ensure comprehensive, meaningful Medicare legislation is signed into law this year. Transitional Coverage for MS Injectables. MS Society advocates have been working for over 18 months to secure immediate, transitional coverage for all four MS immunomodulating medications under Medicare. Since August of 2002, Medicare only covers one of the four MS injectable therapies, if administered in a physician's office. For a beneficiary who cannot take the covered MS injectable, or cannot receive the injection in a physician's office, Medicare coverage of all four MS therapies in any setting (e.g, at home) is critical.

Language providing transitional Medicare coverage for all four MS injectables in '04 and '05 - until an overall Medicare Rx benefit becomes effective - was included in the Medicare package recently sent to the Congressional Budget Office for a cost estimate. This is a promising sign; however, the prospects for immediate MS-specific coverage remain uncertain. It is unclear how many extra provisions lawmakers will be able to include in the final Medicare package as the entire bill must fit within a ten-year, $400 billion spending limit.

Society advocates nationwide have worked especially hard over the past few months to include MS coverage as part of final legislation. Our sincere thanks to the 37 chapters who helped deliver the MS Society's message to key congressional lawmakers and their aides over the course of the year.

Proposed Overall Rx Benefit. We expect the benefit would help beneficiaries with relatively low drug costs (less than $2,200/year) and high drug costs (over $5,000/year). The basic provisions of the new Medicare "Part D" drug benefit are: coverage begins in 2006, with an average monthly premium of $35, and an annual $275 deductible. Thereafter, Medicare would pay 75% of drug costs up to $2,200. After $2,200 in total drug costs, a gap in coverage would exist until drug costs reach $5,000 (or about $3,600 out of pocket). After this point, Medicare would pay about 95% of subsequent "catastrophic" drug expenses that year.

Low Income Protections. Under the agreement, individuals with incomes below 135% ($12,123/year) of the federal poverty level (FPL) generally would not pay premiums, deductibles or the gap in Rx coverage. Additionally, beneficiaries with incomes between 135% of FPL and 150% ($13,470) of FPL would receive sliding scale Part D premium assistance.

Compromises. The new Medicare agreement strikes a balance on a number of critical issues. For example, the compromise includes up to $70 billion in tax-free subsidies to encourage employers to continue providing drug coverage once the Medicare Rx benefit becomes effective. Also, lawmakers amended a controversial House provision calling for nationwide direct price competition between traditional Medicare and private health plans - known as "premium support." The recent agreement includes a temporary, limited pilot project to test competition in up to six metropolitan areas beginning in 2010. Also, in an effort to provide financial aid to the states, Medicare would pick-up the entire cost of covering all Medicare beneficiaries, including those who are covered under both Medicare and Medicaid ("dual eligibles").

Other Medicare Improvements. The Society also has been engaged on a number of other areas of the Medicare reform legislation. Over the months, we have worked with the Consortium of Citizens with Disabilities and other patient and disability organizations. As we understand it, we have succeeded in persuading legislators to oppose additional home-health co-payments, maintain a fair appeals process and coverage standards, and remove annual $1500 therapy caps on physical, speech, and occupational therapy services.

Overall Medicare Bill Prospects: The final Medicare conference agreement awaits passage by both the House and Senate and signature by President Bush. Prospects for enactment are uncertain at this time because total cost estimates are still in the works and because there is still widespread disagreement about the bill's contents.

For more information on the Society's Medicare principles and coverage of MS therapies: http://www.nationalmssociety.org/medicare_factsheet.asp

FUNDING FOR MS RESEARCH

Lawmakers expect to consider the Labor, HHS, and Education (Labor-HHS) Appropriations bill that provides funding for biomedical research at the National Institutes of Health (NIH) as part of an omnibus appropriations package - possibly before December. Neither the Senate nor the House Labor-HHS bill provided adequate FY'04 NIH funding increases. Following the five-year (FY'99 - FY '03) doubling period, NIH is facing its lowest funding level in years - $27.7 billion from the House and $27.9 billion from the Senate. Overall budget constraints have left congressional conferees with minimal funds for NIH, and many in the research community believe it is likely that conferees will split the difference between the House and Senate figures.

The MS Society has been urging Congress to uphold its commitment to NIH funding and has activated its MS Action Network. Advocates are asked to urge their members of Congress to act now to increase NIH funding.

You still have a chance to increase NIH funding! Take action by visiting the Society's NIH Action Alert at: http://www.nationalmssociety.org/advocacy.asp

Please join the MS Action Network at: http://www.nationalmssociety.org/advocacy.asp to receive Federal Updates and MS Action Alerts via email.

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