TO YOUR HEALTH:

Rep. Cardin Introduces Medicare Prescription Drug Bill

WASHINGTON--Rep. Benjamin L. Cardin has introduced The Essential Medicines for Medicare Act, which would provide all beneficiaries with prescription drugs to treat five specific, chronic conditions that have been shown to be highly responsive to medications.

If enacted, the bill would provide outpatient prescription drug coverage within Medicare Part B for the treatment of five diseases--hypertension, major depression, diabetes, rheumatoid arthritis, and congestive heart disease. Benefits would be subject to a $250 annual deductible and copayment of $0 for generic drugs and 20% for non-generics. Low-income beneficiaries would receive assistance with cost sharing. The bill also would establish an annual review process to evaluate the effectiveness of covered drugs and consider additional conditions for coverage.

In late June, the House of Representatives passed a bill that fails to make a prescription drug benefit a guaranteed part of Medicare. Instead, it relies solely on the private insurance market to issue drug-only policies to Medicare beneficiaries. On July 23, the Senate rejected two competing proposals--one that mirrors the House-passed approach, and another that would create a universal benefit within the Medicare program, with a guaranteed benefit package.

The Congressman called the Essential Medicines for Medicare Act "a major step forward because it covers medicines to treat the conditions that affect four out of five seniors, and it includes a mechanism to expand coverage to additional illnesses.....This bipartisan plan will guarantee chronically ill beneficiaries access to medicines. It will save lives, reduce hospitalizations, and decrease future Medicare expenditures." He pointed out that more than one-third of Medicare beneficiaries have no coverage to help pay for their medicines, and most have insufficient coverage.

• Hypertension is a major risk factor for heart disease, stroke and kidney failure, affecting nearly 40% of all Medicare beneficiaries. It is responsible for 32,000 inpatient admissions each year.

• Major depression affects more than one million beneficiaries--more than any diagnosis except heart disease. Medicare spends $1.8 billion each year for 320,000 admissions to treat major depression. Treatment has been found to reduce overall health costs by 29%.

• Diabetes affects 6.3 million elderly Americans. Diabetes is the leading cause of end-stage renal disease, and Medicare spends over $200 million annually on related inpatient care.

• Rheumatoid arthritis affects more than 1.75 million beneficiaries. The annual rate of hospitalization (34%) is nearly twice the rate for all Medicare beneficiaries (18.7%).

• Heart disease is the largest single cause of death for the elderly. Drug therapy can reduce death rates for heart patients by 40%, but only half the people who could benefit from these drugs receive them. Medicare spends $4.2 billion annually for inpatient treatment of heart disease.