News in brief - June 19, 2006

Medicare Part B Rx program deadline extended - Medicare drug caps lead to more hospitalizations

Medicare Part B Rx program deadline extended

Physicians now have until the end of the month to sign up for a voluntary Medicare program that allows them to get Part B drugs from government-approved vendors.

The new deadline to enroll in the Competitive Acquisition Program, or CAP, is June 30. Doctors who decide to utilize the program to receive chemotherapy drugs and other medications typically administered in the office will not need to shop for the drugs themselves and seek Medicare reimbursement after treatment. Instead, they will receive the drugs directly from vendors chosen by the government through a bidding process. The vendor is responsible for billing Medicare for the cost of the drugs and charging the patient for any coinsurance, though physicians will still need to bill Medicare for the cost of administering the medications.

CAP was originally to launch in January but was delayed when an insufficient number of drug vendors participated in the initial bidding. Some oncologists and other physicians also expressed concerns that the program's requirements on doctors could actually increase, rather than decrease, administrative burdens.

Physicians wanting to learn more about the program or to sign up can do so at Medicare's Web site (www.cms.hhs.gov/competitiveacquisforbios/02_infophys.asp).

Medicare drug caps lead to more hospitalizations

Beneficiaries in Medicare managed care plans that place dollar limits on drug coverage spend less on medications but are more likely to skip doses, leading to relatively more hospitalizations and emergency care for that population, according to researchers from the University of California, San Francisco and Harvard University, Cambridge, Mass.

The study, appearing in the June 1 New England Journal of Medicine, found that the roughly 30% average pharmacy savings by Medicare enrollees who had drug caps was nearly completely offset by higher medical costs stemming from the hospitalizations. Chronic disease patients trying to control their blood pressure, lipid levels or glucose levels were at particular risk from poor adherence to their drug therapies if their managed care plan imposed annual limits.