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What if CMS Threw a Party, But Nobody Came?

Year: 2005
Type: article
Abstract: Last year, Medicare set up a new demonstration project — authorized under Section 641 of the new Medicare legislation — that had all the makings of a wildly popular drug subsidy. Informally called the “Section 641 demo” (from Section 641 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003), the Medicare Drug Replacement Demonstration (MRDD) sought to help some beneficiaries get a jump on the Medicare Part D drug benefit that kicks in on Jan. 1, 2006. The Centers for Medicare and Medicaid Services chose three major disease categories — cancer, multiple sclerosis, and rheumatoid arthritis — and began assembling a list of self-injectable drugs that could immediately replace the physician-administered medications currently provided as a Part B benefit. Qualified beneficiaries who signed up through their physicians and who used one or more of these drugs would be entitled to the same benefit to become available for other medications in 2006. Medicare sought strict limits on the program, however, capping the number of people who could sign up and the amount of money that could be provided. “A lot of people thought we would be inundated with these folks,” says a Medicare official, speaking on condition of anonymity. It wasn’t an unreasonable assumption, considering that the drugs covered by the demonstration included some of the most expensive biotech agents on the market — exactly the kind of products that have prompted many beneficiaries to plead for assistance. From Medicare’s perspective, the Section 641 demo is a winner despite the slower-than-expected stream of patients who are signing up. Over the protests of patient advocates in all the disease areas, Medicare officials ultimately decided to cap the program at 50,000 with a $50 million budget. They relented on a key point: rather than forbid off-label drug use, Medicare agreed to reimburse for all indications covered by standard drug compendia. Medicare also created a lottery to allow random selection of applicants. The lottery ultimately would be cast on the agency’s shelf, however, because the expected onslaught of patients in need failed to materialize.
Author: John Carroll
Language: English
Open Access status: green
OpenAlex ID: W561863799
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