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1994.02.02 : Medicare Coverage of Oral Chemotherapy Drugs

FOR IMMEDIATE RELEASE                   Contact: Anne Verano
Wednesday, Feb. 2, 1994                          (202) 690-6145

     A new Medicare benefit in 1994 will help cancer patients pay
for prescribed chemotherapy pills they can buy from their local
pharmacies and administer to themselves, HHS Secretary Donna E.
Shalala announced today.

     Secretary Shalala said coverage of oral chemotherapy drugs
"will be especially valuable to cancer patients who currently must
travel long distances to reach doctor's offices or hospital
outpatient facilities to receive Medicare-covered administration of
the drugs."

     Expected to help approximately 7,000 Medicare cancer patients
in 1994, the new benefit was effective Jan. 1.    

     Medicare generally does not cover self-administered drugs.
However, the Omnibus Budget Reconciliation Act of 1993 authorizes
Medicare to cover anti-cancer pills that are purchased for self-
administration.      

     The new coverage for anti-cancer drugs is a Medicare Part B
benefit for which Medicare will pay 80 percent of approved charges
after beneficiaries have met their $100 annual deductible.  

     Pharmacies are required to submit claims for beneficiaries.
The claims for Medicare payments for the drugs must be submitted to
regional carriers that process claims for durable medical
equipment. 

     Bruce C. Vladeck, administrator of the Health Care Financing
Administration, described the change as "a step toward achieving 
Medicare coverage of nearly all retail prescription drugs, an
important feature of President Clinton's health care reform plan.

     "The costs of prescription drugs are such a heavy burden on
older Americans of limited income that many of them defer buying
the medicine they need," Vladeck said. 

     For Medicare to cover the oral anti-cancer drugs, they must be
prescribed by a physician, be approved by the federal Food and Drug
Administration, and have the same active ingredients and used for
the same medical conditions as the chemotherapy drugs that are not
self-administered.

     Four drugs currently meet those requirements: cyclophosphamide
tablets, etoposide capsules, methotrexate tablets and melphalan
tablets.

     Payments to licensed pharmacies and dispensing physicians will
be made only if they have Medicare supplier billing numbers, but
this requirement will not affect payments of claims submitted for
beneficiaries. Supplier billing numbers may be obtained from: 

The National Supplier Clearinghouse
Post Office Box 100142
Columbia, S.C.  29202-3142
Phone: 1-800-851-3682