Legislation Watch

Medicare Set-Aside Blog on July 11, 2008
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This week, the Senate passed HR 6331, the Medicare Improvement for Patients and Providers Act of 2008, by a sweeping 69-30 majority and is now on the way to the White House. After a complicated run through Congress, HR 6331 allows for a number of improvements in coverage for Medicare beneficiaries. The most notable changes for Parts A & B include improvement in preventive services, reduction in mental health coinsurance rates (to match physical health rates at 20%), and inclusion of intensive cardiac rehabilitation programs and oxygen equipment. Not only that, but the changes to Part D include reinstatement of coverage of barbiturates and benzodiazepines on January 1, 2012, and a revision of the compendia used to determine appropriate indications for drugs (including anticancer drugs).

Furthermore, the competitive bidding program has been delayed for an additional 18 months.

Although none of these changes will immediately affect Medicare Set-Aside allocations, over time we can expect to see larger Part D allocations as commonly used medications that are currently being prescribed for off-label use become “on-label.” Similarly, the old theory that benzodiazepines and barbiturates were too dangerous to quality for Medicare coverage (primarily due to their addictive nature) is no longer the case. Both types of drugs are inexpensive and effective if administered and monitored appropriately.

Stay tuned as we follow this legislation and comment on policy changes as they impact the industry.

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