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  Answer ID  
1543
  Category  
Medicare Modernization Act
  Drug Card
  General
  Medicare Advantage
  Medigap
  Prescription Drug Benefit
Prescription Drug Coverage
  Date Created  
07/29/2004 08:27 AM
  Last Updated  
11/03/2004 08:53 AM

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  What is the Medicare Replacement Drug Demonstration?
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What is the Medicare Replacement Drug Demonstration?

  Answer
 

The enrollment period for the Medicare Replacement Drug Demonstration has been extended beyond September 30, 2004.    Applicants are now being enrolled on a "rolling" basis. Applications completed between the 1st and 15th of the month will have coverage effective the 1st of the next month. Applications completed between the 16th and the end of the month will have coverage effective the 15th of the following month. Enrollment is limited, so submit your application as soon as possible.

The Medicare Replacement Drug Demonstration (MRDD) is a new demonstration mandated under section 641 of the Medicare Modernization Act. Under this demonstration, Medicare will pay for certain drugs that replace other drugs that are currently covered under Medicare Part B. This includes certain drugs for rheumatoid arthritis, multiple sclerosis, cancer, and other serious diseases. Up until now, some of the drugs that treat these conditions were only covered under Medicare when provided in a doctor’s office. A complete list of covered drugs and conditions can be viewed below.

In order to be eligible for this demonstration, you must:

  • have both Medicare A & B, 
  • live in one of the 50 states or the District of Columbia, 
  • have Medicare as your primary health insurance, and
  • have your doctor certify that you need one of the covered drugs for the listed indication.

Because this demonstration is intended to increase access to drug coverage for Medicare beneficiaries, if you already have comprehensive drug coverage through another health insurance such as TriCare, Medicaid, or a retiree policy, then you should not apply. But if you have more limited coverage through a Medicare supplement or Medicare Advantage (Medicare + Choice or Medicare managed care) plan, you may apply.

There is some cost sharing under this demonstration, but the savings are significant and can be over 90% depending upon the cost of the drug. If you are on a limited income, there are even greater savings.

To find out more about this demonstration and how you may apply, go to the The Medicare Replacement Drug Demonstration (click here to view enrollment information) page on www.cms.hhs.gov. On this page you will find a brochure about the demonstration, frequently asked questions and answers, and an application form. Or, you may call the demonstration customer service center at 1-866-563-5386 (TTY number 1-866-563-5387) anytime between 8 am and 7:30 pm Eastern time, Monday – Friday and one of our customer service representatives will be happy to mail you information, answer any questions you may have, and/or assist you in completing the application form.

DRUGS COVERED UNDER THE
MEDICARE REPLACEMENT DRUG DEMONSTRATION

Demonstration Covered Indication

Drug/Biological—Compound Name (Brand Name)

Rheumatoid Arthritis

Adalimumab (Humira)

Anakinra (Kineret)

Etanercept (Enbrel)

Multiple Sclerosis

Glatiramer acetate (Copaxone)

Interferon beta –1a (Rebif, Avonex)

Interferon beta –1b (Betaseron)

Osteoporosis

  (patient must be homebound)

Risedronate (Actonel)

Calcitonin – nasal (Miacalcin – nasal)

Pulmonary Hypertension

Bosentan (Tracleer)

Secondary Hyperparathyroidism

Doxercalciferol (Hectoral)

Paget's Disease

Alendronate (Fosamax)

Risedronate (Actonel)

Hepatitis C

Pegylated interferon alfa-2a (Pegasys)

Pegylated interferon alfa-2a (PEG-Intron)

CMV Retinitis

Valcyte (Valganciclovir)

Anti-Cancer

 

   Cutaneous T-cell lymphoma

Bexarotene (Targretin)

   Non-small cell lung cancer

Gefitinib (Iressa)

   Epithelial ovarian cancer

Altretamine (Hexalen)

   Chronic Myelogenous Leukemia

Imatinib Mesylate (Gleevec)

   GI Stromal Tumor

Imatinib Mesylate (Gleevec)

   Multiple Myeloma

Thalidomide (Thalomid)

   Breast Cancer

Hormonal therapy

         Stage 2-4 only

     

   Anastrozole (Arimidex)

   Exemestane (Aromasin)

   Letrozole (Femara)

   Tamoxifen (Nolvadex)

   Toremifene (Fareston)

   Prophylactic agent to reduce ifosfamide-induced hemorrhagic cystitis

Mesna (Mesnex)

   Acromegaly

Pegvisomant (Somavert)


 
 
 
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