Many Pharmaceutical Companies Plan To Eliminate Charitable Programs

The Philadelphia Inquirer on Thursday examined pharmaceutical companies that plan to eliminate charitable prescription drug programs for seniors enrolled in the new Medicare prescription drug benefit. Last year, the pharmaceutical industry donated $4.1 billion wholesale value in prescription drugs through tax-deductible charities.

However, under a decision released last week by the HHS Office of Inspector General, Medicare beneficiaries who enroll in the new prescription drug benefit will lose eligibility for the medications donated through the charities. According to the Inquirer, an estimated three million to four million Medicare beneficiaries nationwide will lose access to prescription drugs under the charitable programs on Jan. 1, 2006, as a result of the decision.

Some pharmaceutical companies -- such as Pfizer, Bristol-Myers Squibb and Merck -- have said that they will allow Medicare beneficiaries to decide whether to enroll in the prescription drug benefit or continue to receive medications through their charitable programs.

Amy Rose, a spokesperson for Merck, said, "Our broad interest is making sure that the people who need them have access to their medicines. That's the overall goal of everyone in the industry."

However, other pharmaceutical companies -- such as AstraZeneca, Wyeth and GlaxoSmithKline -- have said that they will eliminate their charitable programs for Medicare beneficiaries, regardless of whether they decide to enroll in the prescription drug benefit.

Carla Burigatto, a spokesperson for AstraZeneca, said, "Our program always has been to provide access for people with no other coverage."

Title II Community Aids National Network, a coalition of HIV/AIDS groups, has called on federal officials to revise the HHS OIG decision. In addition, the Pharmaceutical Research and Manufacturers of America has asked CMS to clarify the decision to allow Medicare beneficiaries who enroll in the prescription drug benefit to retain access to medications under their charitable programs "when their expenses hit a gap in coverage -- the so-called doughnut hole," in which annual prescription drug costs reach between $2,250 and $5,100, the Inquirer reports (Ginsberg, Philadelphia Inquirer, 11/17).

Meanwhile, problems with the prescription drug plan finder tool on Medicare Web site this week have affected enrollment in the prescription drug benefit, the Detroit News reports. According to the News, the tool, which had more than one million visitors on Sunday, "became overwhelmed by traffic" on Tuesday and "was still moving slowly Wednesday." Meanwhile, the Medicare toll-free hotline "became overloaded with callers forced to wait or leave messages seeking help," the News reports.

As a result, several agencies in the Detroit area had to cancel appointments to help Medicare beneficiaries enroll in the prescription drug benefit, and some agencies said that beneficiaries might have to wait days or weeks to reschedule.

Robert Hayes, president of the Medicare Rights Center, said, "The information on the Web site is unavailable and incomplete and up and down in different places -- it's clearly a work in progress."

CMS spokesperson Peter Ashkenaz said that the agency will address problems with the Web site by Thursday and that Medicare officials have increased service on the program's toll-free hotline to meet demand. "We're doing everything as quickly as we can," he added (Terlep, Detroit News, 11/17).

USA Today on Thursday published a question-and-answer article on the Medicare prescription drug benefit with former Sen. John Breaux (R-La.), current chair of the Medicare Rx Education Network. The article addressed the cost and complexity of the prescription drug benefit, problems with enrollment in the program, employer prescription drug coverage and issues for low-income beneficiaries (USA Today, 11/17).

In related news, staff members of the Medicare Payment Advisory Commission have raised concerns that revisions in Medicare reimbursements for chemotherapy medications administered in physician offices could result in "more costly hospital-based care," CQ HealthBeat reports. Under the 2003 Medicare law, CMS reduced Medicare reimbursements for chemotherapy medications to address overpayment concerns and increased reimbursements for the administration of the treatments.

The revisions sought to address a system of "cross-subsidization," in which overpayments to physicians for the cost of chemotherapy medications were balanced by underpayments for the administration of the treatments.

However, MedPAC staff member Joan Sokolovsky on Wednesday said that the difference between Medicare reimbursements for chemotherapy medications and their market prices has decreased and that some physicians have said they will no longer absorb the cost of the treatments when patients cannot afford them.

According to MedPAC researchers, the revisions in Medicare reimbursements for chemotherapy medications to date have not resulted in decreased access for beneficiaries. However, they found that an increased number of physicians have begun to refer patients who cannot pay out-of-pocket for chemotherapy medications to more costly hospitals for treatment.

The practice could result in higher costs for Medicare and overcapacity at hospital outpatient treatment centers, MedPAC researchers said. MedPAC plans to report to Congress by Jan. 1 on whether the revisions in Medicare reimbursements for chemotherapy medications have affected access for beneficiaries, quality of care and physician practices (CQ HealthBeat, 11/16).

Several interactive broadcast and online forums will include discussions on the Medicare prescription drug benefit on Thursday:

• C-SPAN's "Washington Journal": The program is scheduled to include an interview with House Energy and Commerce Health Subcommittee Chair Nathan Deal (R-Ga.) ("Washington Journal," C-SPAN, 11/17). The complete segment will be available online in RealPlayer and Windows Media after the broadcast.
  
  
• WAMU's "The Diane Rehm Show": Guests on the program are scheduled to include Diane Archer, founder and special counsel at the Medicare Rights Center; Leslie Norwalk, deputy administrator of CMS; and Julie Rovner, NPR health policy correspondent (Rehm, "The Diane Rehm Show," WAMU, 11/17). The complete segment will be available online in RealPlayer and Windows Media after the broadcast.
  
  
• CMS Administrator Mark McClellan is scheduled to answer questions about the Medicare prescription drug benefit on Thursday at 4 p.m. ET in an "Ask the White House" chat. A transcript of the chat will be available online.