News in brief - Feb. 10, 2003

Brochure offers help on advance beneficiary notices - Supreme Court to rule on legality of Maine prescription drug program - Out-of-pocket Medicare costs vary - Bush budget would boost funding for generic drug approvals

Brochure offers help on advance beneficiary notices

The Centers for Medicare & Medicaid Services has issued a brochure aimed at helping physicians decide when they should give patients advance beneficiary notices. "What doctors need to know about the advance beneficiary notice" includes decision trees for ABNs in general cases and for situations involving the Emergency Medical Treatment and Active Labor Act.

The notices are intended to allow Medicare patients to make an informed decision about whether to receive an item or service that Medicare probably will not cover. A list of items or services for which Medicare never pays is also included.

The brochure can be downloaded from CMS' Web site (http://cms.hhs.gov/medicare/bni/).

Supreme Court to rule on legality of Maine prescription drug program

The U.S. Supreme Court in January heard oral arguments in a case that is expected to determine whether states can require pharmaceutical companies to offer discounts for residents who do not qualify for Medicaid. A decision in the case is expected later this year.

Under the Maine Rx program, a company that refuses to offer a discount to non-Medicaid-eligible residents will have its medication placed on a prior authorization list.

The lawsuit brought by the Pharmaceutical Research and Manufacturers of America argued that the program illegally would restrict Medicaid patients' access to prescription drugs and would interfere with the federal Medicaid program.

The National Medical Assn. said doctors should have the full authority to prescribe any approved drug without state officials interfering. "Doctors don't practice assembly-line medicine," said NMA President L. Natalie Carroll, MD.

"Patients are individuals, and there is no such thing as a one-size-fits-all drug."

Out-of-pocket Medicare costs vary

Medicare beneficiaries face wide variation in out-of-pocket costs, depending on their supplemental insurance coverage, said a recent study published by the Kaiser Family Foundation. Researchers found that, where available, Medicare+Choice plans are often, but not always, less costly than medigap plans. Researchers also found that premiums don't always provide a good indication of future out-of-pocket costs.

The report, "Paying for Choice: The Cost Implications of Health Plan Options for People on Medicare," can be found in pdf form on the Kaiser Web site (http://www.kff.org/content/2003/6060/6060.pdf).

Bush budget would boost funding for generic drug approvals

The Bush administration is expected to propose a $13 million increase for the Food and Drug Administration to improve access to generic drugs, said Health and Human Services Secretary Tommy Thompson. The FDA would use the additional funds, which would be included in the president's 2004 budget proposal, to hire 40 new experts in its generic drug program.

"President Bush's proposed budget would speed up generic drug reviews to make safe, effective generic drugs available to consumers who want lower-cost alternatives to popular brand-name drugs," Thompson said.

If approved by Congress, the funding hike would build on the administration's October announcement of a proposed regulation that would eliminate the current practice that allows brand-name pharmaceutical manufacturers to repeatedly obtain 30-month stays to block the approval of generic versions of their drugs. That regulation would also prevent manufacturers from blocking generic competition by filing frivolous patents.