Reviews are Mixed on Medicare
Discount Drug Card
As of June 1, 2004, 2.87 million Medicare beneficiaries
had enrolled in the Centers for Medicare and Medicaid Services
(CMS) prescription drug card program. Supporters have heralded
the new program as a significant step in addressing the high
cost of prescription drugs for the nation’s seniors,
while detractors question the true cost-savings of the program.
A CMS
analysis found that Medicare-approved drug discount cards
could save beneficiaries 11.3-17.9 percent over the national
average retail price. Yet, reports released by AARP and Families
USA cast doubt on the efficacy of the Medicare drug discount
card to offset the high cost of prescription drugs. Both groups
highlighted the fact that prescription drug prices are rising
faster than the rate of inflation. The Families
USA report found that the average price increase for the
top 30 brand-name drugs used by older Americans was 6.5 percent,
while the AARP
study reported an average price increase of 6.9 percent
for over 200 drugs. The rate of inflation for 2003 was 1.9
percent.
Medicare
to Pay for Unclassified, FDA-Approved Drugs in Outpatient
Settings
In compliance with the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003, CMS issued instructions for
reimbursing FDA-approved drugs that have not been assigned
a product-specific HCPCS billing code. Hospitals can now use
a new code (C9399) to bill Medicare for approved but unclassified
drugs. The payment rate for the drug will be set at 95 percent
of the average wholesale price, as determined by the Medicare
contractor. Hospitals may bill retroactively to January 1,
2004 for these drugs.
Agency
Issues Warning on Dangers of Secondhand Smoke
In the April 24 issue of the British Medical Journal,
the Centers for Disease Control and Prevention (CDC) issued
a pointed
warning on the dangers of secondhand smoke, lending new
ammunition in the fight to enact smoke-free laws and ordinances
in states across the country. The CDC advisory accompanies
a study that found a significant decrease in the number of
hospital admissions for acute myocardial infarction while
a six-month public smoking ban was in effect in Helena, Montana.
The advisory marks a first-ever acknowledgement by the CDC
of the deadly effect that secondhand smoke can have on cardiovascular
patients.
New
Hope for Tobacco FDA Regulation Legislation in 2004
Identical bipartisan legislation (S.2461/H.R.4433) was introduced
in both the U.S. House of Representatives and Senate that
would grant the Food and Drug Administration (FDA) oversight
of tobacco products. Sens. Mike DeWine (R-Ohio) and Edward
Kennedy (D-Mass.), along with Reps. Henry Waxman (D-Calif.)
and Tom Davis (R-Va.) are the bill’s sponsors. The ACC,
the Campaign for Tobacco Free Kids, and even tobacco industry
leader Philip Morris USA support this legislation. The bill
would not allow the FDA to ban cigarettes, but the agency
could regulate tobacco products, reduce usage of the additive
nicotine, curb advertising to children, and mandate the use
of bolder health warnings on tobacco packaging. In addition,
lawmakers have assured bill proponents that a tobacco farmer
buyout provision could be linked to the FDA legislation once
on the Senate floor, making it more attractive to lawmakers
representing tobacco-growing states.
Justice
Department Investigates Anthem Over "Most-Favored-Nation"
Clause
Anthem is facing a federal inquiry over language in many of
its contracts requiring physicians and hospitals to provide
exclusive discounts to the health plan. This language, also
known as a most-favored-nation clause, allows Anthem to adjust
its payment levels to match discounts given to other plans.
Prevalent in health care contracts around the country, most-favored-nation
clauses are gaining new scrutiny as federal courts have deemed
the clauses as anticompetitive in recent years. The Justice
Department’s inquiry into most-favored-nation clauses
is ongoing. (Associated Press, 5/15)
Medical
Liability Bills Make Progress in State Legislatures
Legislation capping non-economic damages at $300,000 in medical
malpractice lawsuits was signed into law by Oklahoma Gov.
Brad Henry (D). The bill (HB.2661) was passed as an emergency
measure after hours of debate and will go into effect immediately.
Although many in the medical community praised the new law,
some opponents pointed to deficiencies, including a provision
that allows a judge or jury to adjust the cap on non-economic
damages if certain criteria are met. (The Oklahoman,
5/29)
The
New Jersey State Legislature has passed and sent to Democratic
Gov. James McGreevey’s desk legislation (A.50) that
would establish a temporary $78 million fund to help physicians
pay for the ever-increasing cost of medical liability insurance.
Although the bill does not impose a limit on non-economic
damages in malpractice lawsuits, it does set new requirements
for initiating a medical malpractice lawsuit and authorizes
the state insurance commissioner to lower medical liability
insurance rates deemed excessive by her office. (Newark
Star-Ledger, 5/25)
New
Biotech Venture to Study Cell Therapy for Heart Disease
Medtronic Inc. and Genzyme Corp. announced a joint venture
to study the use of cell therapies to repair damaged heart
tissue. The new company, to be called MG Biotherapeutics,
is funding a Phase 2 clinical trial to test whether cell therapy
can reverse muscle damage following a heart attack. Researchers
plan to use skeletal muscle or myoblast cells from a patient’s
leg to repair cardiac muscle damage. MG Biotherapeutics hopes
to translate this research into commercial use within the
next four to six years. (Star-Tribune, 6/2)
Advocacy
Weekly is a product of the Advocacy Division of the American
College of Cardiology. Questions or comments regarding this
publication should be directed to the Advocacy Division at
800-435-9203 or to advocacydiv@acc.org.
Copyright
© 1996-2004
American College of Cardiology
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