More MS news articles for April 2000

Bliley Hails Bill on 'Self-Injectable' Medicare Drug Coverage

Tuesday April 4, 12:17 pm Eastern Time
Company Press Release
SOURCE: House Commerce Committee

WASHINGTON, April 4 /PRNewswire/ -- Chairman Bliley today made the following announcement regarding a bill introduced by Health and Environment Subcommittee Chairman Michael Bilirakis (R-FL), that will guarantee Medicare coverage of life-saving self injectable drugs introduced in the House yesterday. The introduction of the bill, H.R. 4149, "Medicare Drug Coverage Preservation Act of 2000," follows a hearing which reviewed a 1997 policy change by the Health Care Finance Administration (HCFA) which denied such coverage.

"I was shocked when HCFA terminated coverage of self-injectable drugs in August 1997," said Bliley, an original cosponsor of the bill. "It is alarming when the federal government turns Medicare coverage on and off like a light switch. One minute certain medicines are covered and one minute they are not.

"This bill will guarantee that the lights will stay on and those who rely on Medicare will have access to these important therapies without the threat of sudden regulatory changes."

Following the hearing on March 23, one of the witnesses, Mariellen Rybicki, wrote Chairman Bliley expressing concern over HCFA's testimony: " ... after hearing the agency representative testify, I left that day thinking that the agency had every intention of once again terminating this coverage when their directive expires later this year."

This bill ensures that Medicare beneficiaries who are receiving life- saving injectable drugs and biologicals continue to have access to those therapies consistent with federal law. This bill continues a drug coverage policy that has been in effect since the establishment of Medicare 35 years ago by ensuring that patients, who cannot self-administer injectable drugs, continue to get those drugs administered by their physician and covered under the Medicare program.

The legislation reverses a 1997 HCFA directive which had the effect of limiting coverage for injectable drugs for certain Medicare beneficiaries. Prior to August 1997, Medicare generally covered injectable drugs and biologicals when administered "incident to" physicians services -- that is, when administered in a physicians office. These drugs were generally not covered if a patient self-administered, however.

Unfortunately in August 1997, HCFA issued a Program Memorandum to Medicare carriers which removed significant discretion in determining which patients were able to self-administer drugs and which patients needed the aid of a physician to administer these drugs. The Program Memorandum led carriers to interpret the policy to mean if any individual, regardless of their disability or infirmity, could possibly self-administer the product, Medicare would not cover it.

HCFA reversed its own 33 year old, noncontroversial policy overnight, and began denying coverage of drugs and biologicals that they had previously paid for. As a result, many Medicare patients with multiple sclerosis, cancer, AIDS and other life-threatening and debilitating diseases have had their coverage limited or denied. Many live with the fear that the coverage they have today will not be there tomorrow.

Congress attempted to address this issue by placing a one year moratorium on HCFA's ability to change this coverage policy in the Consolidated Appropriations Act for Fiscal Year 2000. Only two weeks ago on March 17, HCFA finally issued a directive to its carriers instructing them to restore the coverage policy that was in effect prior to the August 13, 1997 Program Memorandum -- four months after Congress passed a law requiring the agency to change its policy.

H.R. 4149 has the following original cosponsors: Clay Shaw (R-FL), Tom Bliley (R-VA), Jim Greenwood (R-PA), Rick Lazio (R-NY), Richard Burr (R-NC), Ed Bryant (R-TN), Nancy Johnson (R-CT), and Ed Towns (D-NY).

Hearing testimony and other committee information can be obtained on the House Commerce Committee Website:

SOURCE: House Commerce Committee