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Press Release -- 8.21.04

Medicare Will Pay for Selected Drugs Starting This Fall

Denver, CO. The Centers for Medicare and Medicaid is implementing a prescription drug benefit for Medicare beneficiaries. The goal of the program is to provide tens of thousands of dollars worth of help in purchasing critical medicines, in advance of the new benefit that will start in 2006.

According to Medicare, the first 50,000 people to apply for the program will be eligible to receive services. Applications must be received by September 30, 2004. The program will end December 31, 2005. At that time, the individual will be able to join the Medicare Prescription Drug program.

The demonstration program is designed for people who are receiving the approved drugs and are suffering from rheumatoid arthritis, multiple sclerosis, osteoporosis, pulmonary hypertension, secondary hyperparathyroidism, Paget's Disease, Hepatitis C, or CMV retinitis. In addition, individuals who have T-cell lymphoma, non-small cell lung cancer, epithelial ovarian cancer, myelogeneous leukemia, GI stromal tumor, multiple myeloma, and stage 2-4 breast cancer may also be eligible for assistance.

To be eligible for the demonstration program, a beneficiary must be enrolled in Medicare Part A and B, Medicare must be their primary payer, and the beneficiary may not have comprehensive drug coverage through other sources. Individuals who receive TriCare, Medicaid, or an employer or union sponsored plan are not eligible.

A beneficiary will also need a signed certification from a doctor that the drug is required. Individuals do not have to be taking the drugs to be eligible for the program, only that the physician believes they would benefit from the drug.

Individuals who are enrolled in a Medicare HMO or the original Medicare fee-for-service program are eligible. Individuals in a Medicare HMO may have a better benefit through the HMO than through the demonstration program. Regardless of who pays for prescription drugs, anyone who has an annual dollar limit on their prescription drug benefit is eligible.

Individuals who have a Medicare Approved Prescription Drug Card are also eligible to receive the drugs. The drugs provided through the demonstration program can not be covered by MediGap insurance Plans H, I and J, however, those plans can cover other drugs and the individual can still enroll in the demonstration program.

Under the program, individuals will pay an $85 deductible for September through December 31, 2004 and another $250 for January 1, 2005 to December 31, 2005. After the deductible has been met, the individual must pay 25% of the cost of the drugs ($165 in 2004 and $500 in 2005). In 2004, individuals will then be responsible for the next $950 in costs ($2,850 in 2005). After that, the individual will pay the greater of 5% or a fixed co-payment of $2 for generic or preferred multi-brand drugs or $5 for all other drugs.

Individuals whose income is less than $13,965 ($18,735 for a couple) may have to pay even less for the prescriptions. To be eligible, individuals also must have less than $10,000 in resources ($20,000 for a couple). The house, car, and personal property are excluded.

To enroll in the demonstration program, beneficiaries must complete an application, have the physician certify their need for the covered drug, and submit the forms to TrailBlazer Health Enterprises, PO Box 5136, Timonium, MD 21094 or fax to 410-683-2933. The application is available at http://www.cms.hhs.gov/forms/cms10113.pdf

Once enrolled in the program, individuals will receive a specific prescription drug card to use when purchasing the drugs covered by the demonstration program. Individuals can have the prescriptions filled at a local pharmacy that is part of Caremark's nationwide network or purchase them through Caremark's mail order service.

Under Caremark's specialty mail order pharmacy program, all of the routine supplies needed (needles, syringes, sharps containers, and so forth) are provided at no extra cost.

For assistance in enrolling in the program, call 303-333-3482.