Respiratory drug policy uncertain with Bush plan to revamp Medicare program

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Monday, March 31, 2003

WASHINGTON – Will COPD patients see their respiratory medication coverage change under President Bush’s new Medicare reform plan?

Industry watchers say it’s too early to tell, but that the Administration has made no secret of its preference for turning Medicare into a privatized, managed care-style system. And if beneficiaries are strongly persuaded to enroll in the managed system to gain drug benefits, COPD patients may see their current albuterol and ipratropium coverage under fee-for-service vanish.

It’s one possible scenario, said Dave Williams, director of government relations for Elyria, Ohio-based Invacare.

“Based on the verbal transmissions to Congress, one way or another the issue of respiratory medications has to be dealt with,” Williams said. “Whether it’s part of the reform bill or through regulatory action, they will deal with it.”

A 12-page outline to the Bush plan, issued in early March, is labeled “21st Century Medicare: More Choices-Better Benefits, A Framework to Modernize and Improve Medicare.” The document contains no legislative language, which means that Congress is expected to flesh out the details, AAHomecare President and CEO Tom Connaughton said in a published statement.

“The principles of Medicare reform presented by the President are just that – principles,” Connaughton said. “They explain the President’s concept of a Medicare program with managed care options, but they do not set out the details. It will be up to Congressional leaders to put together the legislative package and move it through.
Reps. Bill Thomas (R-Calif.) and Billy Tauzin (R-La.), along with Sens. Charles Grassley (R-Iowa), John Breaux (D-La.) and, to some extent, Senate Majority Leader Bill Frist (R-Tenn.), are expected to be instrumental in crafting the legislation.

The Bush plan will reportedly extend drug benefits to both fee-for-service participants and managed Medicare enrollees. The managed plan will offer more extensive drug coverage than the fee-for-service system, which proposes to pay for drugs only when out-of-pocket expenses exceed $4,500 to $7,000.

Once the legislative language is forged for the reform plan, COPD patients could conceivably see the coverage for respiratory medications shift from fee-for-service to the managed Medicare program, Williams said.

“It would likely eliminate the inducement to stay in fee-for-service,” he said.

Grouping all drug coverage together under one umbrella may ultimately be to COPD patients’ advantage, though. While respiratory medications are covered under Part B because they are used in conjunction with oxygen equipment, other drugs that pulmonary patients typically require are not covered under the current fee-for-service system.

“Next to diabetics, COPD patients comprise the largest segment of drug utilization patients,” said Micky Letson, president of Decatur, Ala.-based Letco Medical. “They commonly need metered dose inhalers, blood pressure medications, cholesterol medications and other maintenance drugs.”

Still, no matter what structure the reform plan takes, Letson maintains that COPD patients are likely to be confused by the new policy.

“Based on what I’ve heard, I’d say 70% to 80% of COPD patients don’t know what President Bush is proposing,” he said. “I’m afraid that they’ll misunderstand and make the wrong decision regarding the plan that is best for them.” HME

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