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GOVERNMENT & MEDICINEMedicare drug choices called too restrictiveFinal Medicare drug plan recommendations remain largely unchanged from an earlier draft.By David Glendinning, AMNews staff. Jan. 24, 2005. Washington -- Medicare drug formulary guidelines commissioned by the federal government still omit some therapies that physicians deem vital to their patients, and doctors' groups worry that drug plans could decide against covering the medicines as a result. The recommendations, which the U.S. Pharmacopeial Convention released to Medicare officials last month, contain the same total number of unique drug therapeutic categories and pharmacological classes as a proposed model that USP unveiled in August 2004. The group does not list any actual medicines by name, but insurers that cover two drugs in each category or class will receive less regulatory scrutiny when it comes time for the Centers for Medicare & Medicaid Services to approve plans' offerings. The advisory panel modified some of the details of its original proposal, but not to the extent called for by some physician groups and patients' advocates. The American Medical Association is still reviewing the final USP product. Specialty medical groups remain concerned that the regulatory safe harbor offered by CMS will allow plans to deny coverage for drugs needed by beneficiaries with certain conditions. Doctors treating Medicare seniors with osteoporosis, for instance, might encounter plans that will not cover bisphosphonates, calcium-regulating hormones or other key bone disease agents. If CMS gives its blessing to such plans, millions of seniors could forgo the treatments and put themselves at risk for serious injury, said C. Conrad Johnston Jr., MD, an endocrinologist in Indianapolis. [...]Full text of AMNews content is available to AMA members and paid subscribers.
Copyright 2005 American Medical Association. All rights reserved.
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