Congress May Approve Medicare Coverage of Oral Treatments for Cancer in Absence of a Prescription Drug Benefit

Congress "appears likely" to pass a bill (S 913) that would provide Medicare coverage for cancer drugs taken orally, a move that would "provide tangible help" for many beneficiaries and "political benefits" for lawmakers in the absence of a comprehensive Medicare prescription drug benefit, the New York Times reports. Medicare only covers prescription drugs administered in hospitals and some medications, including cancer injection or infusion treatments, administered in doctors' offices. The bill, sponsored by Sens. Olympia Snowe (R-Maine) and John Rockefeller (D-W.Va.), would offer coverage to Medicare beneficiaries for oral cancer drugs, including tamoxifen, for breast cancer; Gleevec, for some forms of leukemia and gastrointestinal tumors; and thalidomide, for multiple myeloma, a blood cancer. Rep. Deborah Pryce (R-Ohio) has introduced a similar bill in the House. More than 20% of the 40 million Medicare beneficiaries receive some cancer treatment each year, and the Times reports that a "greater reliance" on oral drugs to treat tumors has left many seniors unable to cover the cost.

Lawmakers and cancer patient advocates said that the oral cancer drug legislation may serve as a "significant first step" toward a comprehensive Medicare prescription drug benefit, an issue that has prompted "profound disagreements" between Republicans and Democrats. Samuel Turner, an attorney who has helped coordinate support for the bill, said that "in the final days of this Congress, the legislation to cover oral anti-cancer drugs may well be an attractive first step toward the eventual goal of comprehensive drug coverage." The American Cancer Society, the National Breast Cancer Society, the National Breast Cancer Coalition, the American Society of Clinical Oncology, AstraZeneca PLC, Bristol-Myers Squibb Co., Novartis AG and Celgene Corp. support the legislation. The Times reports that the legislation also "illustrates how Washington works: Lobbyists for a modest, well-defined goal are often more effective than sweeping, fundamental changes." Ellen Stovall, executive director of the National Coalition for Cancer Survivorship, said, "We certainly support comprehensive prescription drug benefits for seniors, but the fiscal and political hurdles to achieving that goal this year are daunting. We would rather have a significant first step toward coverage than no progress at all" (Pear, New York Times, 4/29).

In other Medicare news, House Republicans have begun to draft a bill that would reduce scheduled increases in Medicare reimbursements to hospitals and may include a "modest copayment" for home health care services, one of the few areas in Medicare that does not charge a copayment, the Times reports. House Republicans plan to include the provisions in a bill to establish a Medicare prescription drug benefit that they plan to move through the House before the Memorial Day recess. Lawmakers hope that the hospital reimbursement and home health care copayments provisions in the bill will allow Medicare to increase reimbursements for physicians. Some doctors have begun to refuse to treat new Medicare patients as a result of a 5.4% reduction in reimbursements that took effect in January. Under current formulas, physicians will face an additional 17% reduction in Medicare reimbursements between 2002 and 2005, the Times reports. The Bush administration has said that lawmakers must offset increases in Medicare reimbursements to physicians with reductions for other providers. Under current law, hospitals will receive an increase in Medicare reimbursements equal to the inflation rate, about 3% per year, between 2004 and 2007. The House Republican bill, developed over the past few weeks by the House Ways and Means Committee and the House Committee on Energy and Commerce, would reduce the scheduled increase by one-half of a percentage point each year, which would save Medicare $5 billion over five years. In the area of home health care, House Republicans said they may propose a "modest" copayment for each 60-day period in which beneficiaries receive care. In 1997, Medicare spent $17.5 billion on home health care, a figure that dropped to $9.1 billion in 2001. However, the Congressional Budget Office estimates that Medicare will spend $12.5 billion on home health care next year and $17 billion in 2005.

Patient advocates, hospitals and home health care groups oppose the House Republican bill. "Hospitals are still recovering from previous Medicare cuts and face mounting new cost pressures. So we believe that a full inflation update is in order for 2003, and that cuts should not be considered for future years," Chip Kahn, president of the Federation of American Hospitals, said. In addition, past proposals to establish copayments for home health care have faced opposition from Democrats and lobbyists who "complained that the sickest patients would be hardest hit." William Dombi, vice president of the National Association for Home Care, said, "We have concerns about the impact of a co-payment on Medicare beneficiaries. We don't want a new tax on people who use our services. Most of the people we serve are poor or nearly poor" In 1997, the Senate approved a $5 copayment for home health care visits, but lawmakers dropped the proposal in negotiations with the House (Pear, New York Times, 4/27).