Legislators introduce injectable drug bills

June 1, 2000

Pharmaceutical Representative

"The Medicare Drug Coverage Preservation Act of 2000," a bill that would guarantee Medicare coverage of certain injectable drugs, was introduced in the House by Health and Environment Subcommittee Chairman Michael Bilirakis (R-FL).

"The Medicare Drug Coverage Preservation Act of 2000," a bill that would guarantee Medicare coverage of certain injectable drugs, was introduced in the House by Health and Environment Subcommittee Chairman Michael Bilirakis (R-FL).

The bill ensures that Medicare beneficiaries who receive life-saving injectable drugs and biologicals would continue to have access to those therapies consistent with federal law. The 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 physicians 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 biologics when administered in a physician's office. In August 1997, HCFA issued a memorandum to Medicare carriers that removed significant discretion in determining which patients were able to self-administer drugs and which patients needed the aid of a physician to administer injectables.

"I was shocked when HCFA terminated coverage of self-injectable drugs in August 1997," said Rep. Tom Bliley (R-VA), an original co-sponsor 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're not."

Another bill, "The Access to Innovation for Medicare Patients Act of 1999" introduced by Rep. Jennifer Dunn (R-WA), proposes to extend Medicare Part B to include any self-injected biologic that could substitute for a currently covered clinician-administered drug or biological.

The Lewin Group, a Falls Church, VA-based consulting firm, estimated that the Dunn bill would save Medicare $2 million in treatment costs for conditions covered by the bill. "We are dealing here with some of society's most debilitated patients," said Lewin Group study director Catherine Harrington. "These patients find it hard to leave home to travel long distances to specialists or clinics. Coverage of self-injected biologicals would eliminate unnecessary office visits, infusion charges and the staff time associated with infusing products." PR