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Demonstration Project
Medicare Offers Help to Seniors With Flu
Jan. 7, 2004 Senior citizens who get the flu can
get assistance to help pay for antiviral medicines under a demonstration
project announced today by the Centers for Medicare & Medicaid Services
(CMS).
The demonstration is intended to last through May
31, 2005. Each beneficiary can get up to a total of two prescriptions
filled during the demonstration period. The project is designed to help
determine if coverage for these medicines can significantly reduce the
impact of flu on Medicare beneficiaries, especially those currently
without drug coverage.
There are prescription drugs that have been proven
to prevent the flu and its serious complications, and Medicare is taking
steps to make these drugs more affordable, said CMS Administrator Mark
McClellan, M.D., Ph.D. This demonstration program will provide useful
evidence on how prescription drug coverage affects the health and costs
for Medicare beneficiaries ahead of the drug benefit in 2006.
Dr. McClellan emphasized that the flu vaccine
remains the best protection for Medicare beneficiaries and he urged
seniors who have yet to be vaccinated to do so. Adults who are age 65
and older and other Americans with chronic illnesses are in the high
priority group to obtain flu vaccines, and there is an adequate vaccine
supply for these groups.
In the
United States, four antiviral
medications (amantadine, rimantadine, oseltamivir, and zanamivir) are
approved for treatment of flu. Detailed information
about each medication, including dosage and approved persons for use,
may be found at
http://www.cdc.gov/flu/professionals/treatment.
Dr. McClellan added that antiviral medicine could be used in cases of
outbreaks in communities, for residents of institutions or anyplace
where people at high risk for complications from flu are in close
contact with each other, to protect individuals who may be exposed to
flu.
"Because there are reports of increasing flu
activities in some areas of the country, it's important to stay
vigilant," Dr. McClellan said. "People with Medicare who develop
symptoms of flu or find that they may have been exposed to flu should
contact their doctor as soon as possible."
The demonstration is designed for beneficiaries
with Medicare Part B who do not have drug coverage. Beneficiaries can
take their prescription for anti-viral flu treatment directly to a
Medicare participating pharmacy. If the beneficiary has met their Part B
deductible, Medicare will pay 80 percent of the cost of the drug up to
the Medicare allowed payment, which is 95 percent of the average
wholesale price for brand drugs and 90 percent of the average wholesale
price for generic drugs.
Those Medicare beneficiaries who participate in the
Medicare-Approved Drug Discount Card Program will pay 20 percent of your
card sponsors negotiated cost for the drug or 20 percent of the
Medicare allowed payment, whichever is lower. Thus Medicare
beneficiaries with drug discount cards are assured of paying the lowest
copayment level. Those who participate in the programs Transitional
Assistance can also use their $600 drug credit for antiviral medicines.
Medicare Advantage plan members may also
participate. The prescription can simply be taken to a pharmacy to be
filled just as if it would be under traditional Medicare. For
beneficiaries who are treated as part of a covered Part A hospital stay,
the antiviral medicines will also be covered.
Approximately 36,000 deaths are attributed to flu
and pneumonia in the
United States each year, and more than
90 percent of these deaths occur in people age 65 and older. Many of
the deaths occur in patients who experience complications after the flu,
such as pneumonia. These complications can be alleviated with flu
medicines taken early in the course of disease. Some flu medicines have
also been shown to reduce the likelihood of contracting the flu from
someone who may have the flu.
Symptoms of flu often include fever, headache,
extreme tiredness, dry cough, sore throat, runny or stuffy nose, and
muscle aches. The Centers for Disease Control and Prevention reports
that flu activity has been low so far this season. However, the level of
flu activity is unpredictable and the season often lasts until late
spring.
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