News in brief - Jan. 24, 2005

Massive TennCare cuts ahead - Medicare delays defibrillator coverage expansion for coronary patients - Governors write Congress about Medicaid finance, reforms - Drug importer faces federal lawsuit

Massive TennCare cuts ahead

Tennessee Gov. Phil Bredesen recently announced that the state would be moving forward with a modified plan to reduce TennCare rolls by approximately 323,000 adults who are currently covered by the program but are not eligible for basic Medicaid. The state will preserve coverage for the approximately 112,000 children in TennCare who would not otherwise be eligible for basic Medicaid.

The 396,000 adults who are left in the program will have some of their benefits cut, but all 612,000 children will still get full benefits. The governor has battled with patients' advocates who are suing the state over proposed changes to TennCare.

"It might not be the level of care we want to provide, but it's the level of care we can afford without bankrupting our state," said Bredesen. "We're putting limits into what has been the most generous health care program in the nation."

Medicare delays defibrillator coverage expansion for coronary patients

Federal officials are holding off on expanding Medicare coverage of implantable cardioverter defibrillators until the results of a major scientific study have been published.

The Centers for Medicare & Medicaid Services proposed offering the devices to a larger population of coronary disease patients last October after initial study results demonstrated that the ICDs could prevent more cases of sudden cardiac death.

CMS concluded last month, however, that it could not proceed with a final coverage determination until the National Institutes of Health put the study up for peer review and published it in a medical journal.

Until Medicare investigators are able to review the finished report, only patients currently eligible for the ICDs and those who enroll in CMS-approved clinical trials can receive coverage for the defibrillators.

Governors write Congress about Medicaid finance, reforms

The nation's governors sent a letter to congressional leaders last month calling for Medicaid reforms that would alleviate some of the financial burden facing the states.

The bipartisan chairs of the National Governors Assn. reported that the program is consuming an increasingly larger portion of states' budgets and that reforms that would make Medicaid run more efficiently are needed.

"Reform, however, should not be part of a 2006 fiscal year budget reduction and reconciliation process, especially if it does nothing more than shift additional costs to states," the letter states. Any measure that Congress approves must include a provision to transfer Medicare-Medicaid dual eligibles to Medicare, according to the governors.

Drug importer faces federal lawsuit

The U.S. Attorney's Office in the Southern District of New York in December 2004 filed a civil lawsuit against Canada Care Drugs Inc. on behalf of the Food and Drug Administration. The lawsuit alleges that the company illegally imported unapproved and potentially unsafe drugs into the United States.

The complaint states that two undercover purchases by the FDA of FDA-approved drugs yielded unapproved drugs and three packages of another drug at once which it says could be harmful to patients if taken without consulting their physicians.