Monday, January 30, 2006

Medicare Drug Plan Leaves Out Supplies

Medicare Drug Plan Leaves Out Supplies
The benefit covers home IV medication but not the implements and care needed to administer it.

By Ricardo Alonso-Zaldivar, LA Times Staff Writer

WASHINGTON — The new Medicare drug program is denying supplies that seriously ill patients need to administer intravenous antibiotics and other medications at home. As a result, some patients are being referred to nursing homes, and others have had to go into hospitals.

Although no national estimates are available, the number of patients affected — including some with life-threatening diseases such as cancer and multiple sclerosis — could run into the thousands. One Anaheim pharmacy says 200 of its patients are having trouble.

Medicare officials say they are aggressively addressing the problem, which they attribute to restrictions in the law that created the prescription benefit and to difficulty communicating with states, pharmacies and medical providers.

Essentially, the prescription program allows coverage of the drugs but does not pay for the medical supplies and nursing help needed for the home infusion treatments to be safe and effective — a policy that effectively shuts down such treatment for some patients, even though it is substantially cheaper than the alternatives. Two GOP senators warned the Medicare agency last fall that the gap in coverage "may limit access to home infusion therapy."

Home infusion pharmacies say they are overwhelmed trying to help patients deal with the problem. "It's like I'm doing triage in a MASH unit," said pharmacist Michael Rigas, vice president for clinical affairs with Crescent Healthcare in Anaheim....