Help Your Patients Become Aware of the New Medicare Prescription Drug Plans

Thank you for giving me the opportunity to respond to the article, “New Prescription Drug Benefit: The Role of the Oncologist” in this issue of The Oncologist.

The addition of prescription drug coverage may be the most important change to Medicare since it was established, especially for cancer patients. For the first time, individuals with cancer who are covered by Medicare will have access to most oral chemotherapy and other self-administered drugs, such as transdermal patches, to properly manage pain and other cancer-related symptoms.

To those of us who work in this field, the need for this coverage may have seemed obvious. After all, prescription medication is so much a part of preventing and managing disease today that we would be unable to meet our responsibilities to our patients without it. But until the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), there was a gaping hole in Medicare’s coverage of medical care.

That is why the information in the accompanying article is so critical and why it is so important that patients, particularly people who need cancer therapy, actively take advantage of the new drug coverage. The prescription drug benefit Medicare has enacted is voluntary, so patients will need to understand the coverage so that they can make the best choices when signing up. And because we are in the midst of a massive outreach effort to educate patients and providers before enrollment begins on November 15, many may have already asked your advice. We hope you encourage them to join a health plan because we think this will be the best choice for virtually all beneficiaries, both financially and for their health. And if they have questions, encourage them to go to http://www.medicare.gov, where they will find a Medicare prescription drug finder, or to call 1-800-MEDICARE.

We realize that your clinical time is scarce and time with patients is precious. That is why we have tried to make it as easy as possible to refer patients who are the most in need financially to local resources that can help them apply for the limited-income subsidies now so that they can choose a drug plan starting in mid-November. There will be thousands of trained volunteers available to help in communities throughout the United States. A list of those local experts will be delivered to your office this coming October, along with patient education products that you can use to answer any patient or staff questions.

Patients who previously were unable to afford necessary treatments will have broad-based coverage that will cover necessary drugs. Individuals who receive Medicaid as well as Medicare who do not choose a plan will be assigned one starting December 31, 2005, and Medicare will begin picking up the coverage starting January 1, 2006.

Special efforts are being made to assure that people with limited incomes and resources have access to the extra financial help that is available. Your patients need only fill out a four-page form available through the Social Security Administration to determine whether they qualify for extra help. They can call 800-772-1213 or visit http://www.socialsecurity.gov/prescriptionhelp for more information.

People with limited incomes and resources who do not qualify for Medicaid also will receive extra financial help. They will pay no deductible or premium, and have only minimal copays when they fill prescriptions. But they, too, will have to sign up. Information about this extra financial assistance is available from the local Social Security office.

We are simply asking you to tell your patients that this new drug coverage is worth exploring. We are not asking you to counsel your patients on the benefits or drawbacks of employer or union retiree health plans (though the MMA requires these to offer coverage that is at least the equivalent of Medicare coverage). We do not ask you to be able to explain the graded benefit, although you may be asked specifically about enrollees with out-of-pocket drug costs that exceed $3,600. These beneficiaries will pay only 5% of their drug costs above that amount, with no limit in total spending.

All we ask you to do is let your patients know to look for the information that should be coming to them and to alert them that, if they already have coverage at least as good as the Medicare coverage, they can always change to the Medicare benefit without penalty at any time.

You can refer patients to the local, toll-free 800 numbers that you will find in the health care professionals toolkit available on the Centers for Medicare and Medicaid Services Web site (http://www.cms.hss.gov/medlearn/drugcoverage.asp). In addition, please visit the site for the toolkit and other materials to help you inform your patients about Medicare’s new prescription drug benefit.

Finally, alert your office staff that, starting October 13, 2005, there will be a Medicare Prescription Drug Plan Finder at http://www.medicare.gov that will allow your patients to find a plan based on the medications they take and the location of a convenient pharmacy.

Of course, the little time you spend referring patients to resources should pay great dividends for your patients and for your practices because the purpose of providing this coverage is to help our beneficiaries become healthier. In your practice, we hope this translates into better compliance with drugs, fewer readmissions thanks to that compliance, and fewer long-term complications. But I don’t think it is overly dramatic to say that the real reason you are doing this is that access to prescription medication is a mainstay of the 21^st Century medical care that your patients expect you to provide and that our beneficiaries deserve.

Mark McClellan, M.D., Ph.D.

 

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Footnotes

Mark McClellan, M.D., Ph.D.

Following Senate confirmation by unanimous voice vote, Dr. Mark McClellan was sworn in as administrator of the Centers for Medicare and Medicaid Services on March 25, 2004. Dr. McClellan previously served as commissioner of the Food and Drug Administration beginning in November 2002, following Senate confirmation by unanimous consent. During 2001 and 2002, Dr. McClellan served in the White House as a member of the President’s Council of Economic Advisers, where he advised on domestic economic issues and was a senior policy director for health care and related economic issues. From 1998–1999, he was Deputy Assistant Secretary of the Treasury for Economic Policy, where he supervised economic analysis and policy development on a wide range of domestic policy issues.

Dr. McClellan is on leave from Stanford University, where he was associate professor of economics and associate professor of medicine at Stanford Medical School. At Stanford Medical School, Dr. McClellan was a practicing internist and director of the Program on Health Outcomes Research. He was also a research associate of the National Bureau of Economic Research and a visiting scholar at the American Enterprise Institute. Additionally, he was a member of the National Cancer Policy Board of the National Academy of Sciences, associate editor of the Journal of Health Economics, and coprincipal investigator of the Health and Retirement Study, a longitudinal study of the health and economic well-being of older Americans.

Dr. McClellan’s research studies have addressed measuring and improving the quality of health care, the economic and policy factors influencing medical treatment decisions and health outcomes, estimating the effects of medical treatments, technological change in health care and its consequences for health and medical expenditures, and the relationship between health and economic well-being. He has twice received the Arrow Award for Outstanding Research in Health Economics, and he is a Member of the Institute of Medicine. He earned his M.D. from the Harvard University–Massachusetts Institute of Technology (MIT) Division of Health Sciences and Technology and his Ph.D. in economics from MIT. A board-certified internal medicine physician, Dr. McClellan completed his residency training in internal medicine at Brigham and Women’s Hospital in Boston.

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