MEDICARE DEMONSTRATION PROJECT PAYS FOR FLU MEDICINES
Seniors who get the flu can get assistance to help pay for antiviral medicines under a demonstration project announced today by the Centers for Medicare & Medicaid Services (CMS).
“There are prescription drugs that have been proven to prevent the flu and its serious complications, and Medicare is taking steps to make these drugs more affordable,” said CMS Administrator Mark McClellan, M.D., Ph.D. “This demonstration program will provide useful evidence on how prescription drug coverage affects the health and costs for Medicare beneficiaries ahead of the drug benefit in 2006.”
The demonstration is intended to last through May 31, 2005. Each beneficiary can get up to a total of two prescriptions filled during the demonstration period. The project is designed to help determine if coverage for these medicines can significantly reduce the impact of flu on Medicare beneficiaries, especially those currently without drug coverage.
Dr. McClellan emphasized that the flu vaccine remains the best protection for Medicare beneficiaries and he urged seniors who have yet to be vaccinated to do so. Adults who are age 65 and older and other Americans with chronic illnesses are in the high priority group to obtain flu vaccines, and there is an adequate vaccine supply for these groups.
In the United States, four antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved for treatment of flu. Detailed information about each medication, including dosage and approved persons for use, may be found at http://www.cdc.gov/flu/professionals/treatment.
Dr. McClellan added that antiviral medicine could be used in cases of outbreaks in communities, for residents of institutions or anyplace where people at high risk for complications from flu are in close contact with each other, to protect individuals who may be exposed to flu.
"Because there are reports of increasing flu activities in some areas of the country, it's important to stay vigilant," Dr. McClellan said. "People with Medicare who develop symptoms of flu or find that they may have been exposed to flu should contact their doctor as soon as possible."
The demonstration is designed for beneficiaries with Medicare Part B who do not have drug coverage. Beneficiaries can take their prescription for anti-viral flu treatment directly to a Medicare participating pharmacy. If the beneficiary has met their Part B deductible, Medicare will pay 80 percent of the cost of the drug up to the Medicare allowed payment, which is 95 percent of the average wholesale price for brand drugs and 90 percent of the average wholesale price for generic drugs.
Those Medicare beneficiaries who participate in the Medicare-Approved Drug Discount Card Program will pay 20 percent of your card sponsor’s negotiated cost for the drug or 20 percent of the Medicare allowed payment, whichever is lower. Thus Medicare beneficiaries with drug discount cards are assured of paying the lowest copayment level. Those who participate in the program’s Transitional Assistance can also use their $600 drug credit for antiviral medicines.
Medicare Advantage plan members may also participate. The prescription can simply be taken to a pharmacy to be filled just as if it would be under traditional Medicare. For beneficiaries who are treated as part of a covered Part A hospital stay, the antiviral medicines will also be covered.
Approximately 36,000 deaths are attributed to flu and pneumonia in the United States each year, and more than 90 percent of these deaths occur in people age 65 and older. Many of the deaths occur in patients who experience complications after the flu, such as pneumonia. These complications can be alleviated with flu medicines taken early in the course of disease. Some flu medicines have also been shown to reduce the likelihood of contracting the flu from someone who may have the flu.
Symptoms of flu often include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. The Centers for Disease Control and Prevention reports that flu activity has been low so far this season. However, the level of flu activity is unpredictable and the season often lasts until late spring.