You are eligible if you:

• Have Medicare Part A and B, or
• Will have Medicare Part A and B in October, 2004 ;
• Have Medicare as your "primary payer" (i.e., it pays for health services first before other insurers);
• Do not have other comprehensive drug coverage; and
• Live in the 50 states or D.C.

To apply, you must:

1. Fill out an application form; and
2. Submit a form filled out by your doctor certifying your need for one or more of the drugs on the covered list, for specific cancer indications (see table below)

Both forms are available online at http://www.cms.hhs.gov/researchers/demos/drugcoveragedemo.asp
or by calling 1-866-563-5386, Mon.-Fri., 8AM-7:30PM (EST)

• Imatinib mesylate (Gleevec) -- for chronic myelogenous leukemia and gastrointestinal stromal tumor
• Bexarotene (Targretin) -- for cutaneous T-cell lymphoma
• Altretamine (Hexalen) -- for epithelial ovarian cancer
• Thalidomide (Thalomid) -- for multiple myeloma
• Gefitinib (Iressa) -- for non-small cell lung cancer
• Letrozole (Femara) -- for stages 2-4 breast cancer
• Exemestane (Aromasin) -- for stages 2-4 breast cancer
• Anastrozole (Arimidex) -- for stages 2-4 breast cancer
• Tamoxifen (Nolvadex) -- for stages 2-4 breast cancer
• Toremifene (Fareston) -- for stages 2-4 breast cancer
• Mesna (Mesnex) -- for people receiving ifosfamide

There will be 2 application periods:

• July 6 – Aug. 16
• Aug. 16 – Sept. 30

A certain percentage (estimated at 10%) of people will be selected from those who apply between July 6 and August 16. They will have coverage by Sept. 1. All people not selected in this first round will be automatically carried over into the second round.

The remaining participants will be selected from the second round. Their coverage will begin on October 18.

Recipients will be chosen by a random selection process from 2 pools, one with cancer patients and one with non-cancer patients. Applicants will be randomly chosen by a computer program, which will select one cancer patient and then one non-cancer patient, and so on until the limit (cap) is reached.

• The random alternating system will proceed until one of 3 caps is reached -- the $200 million cap designated for cancer patients, the $300 million for non-cancer patients, or the 50,000 person cap.
• The Centers for Medicare and Medicaid Services (CMS) will keep track of the anticipated spending as they select people and will know when to stop enrolling when they hit the caps. This is because as part of the application process, people must submit information about their drug use, income, and assets. (Drug use, income, and asset information will not be used to select applicants -- it will only be used to keep track of spending.)
• Those selected will receive coverage through Dec. 31, 2005; if they want to continue their coverage of these drugs, they must enroll in the Medicare Part D drug benefit to begin in 2006.

People who are selected will be subject to similar cost-sharing as will be required under the new Medicare prescription drug benefit beginning in 2006. (Because CMS is implementing the benefit late in the year, CMS will prorate cost-sharing for 2004.)

Cost-sharing under the standard benefit (Benefit Level 1) will look like this:

Benefit Level 1

• In 2004: $85 deductible; 25% coinsurance until you reach $745 in drug spending (including deductible); no coverage for drug spending between $746 and $1,695, and then the greater of 5% co-pay or $2 for generic drugs and $5 for brand-name drugs.
• In 2005: $250 deductible; 25% coinsurance until you reach $2,250 in drug spending (including deductible); no coverage for drug spending between $2,251 and $5,100, and then the greater of 5% co-pay or $2 for generic drugs and $5 for brand-name drugs.

Cost-sharing for low-income beneficiaries (Benefit Levels 2, 3, 4, & 5) will look like this:

Low-income beneficiaries will pay based on their annual income and financial assets. They will be placed in one of four Benefit Levels using this information, with their payment based on their Benefit Level -- detailed qualifying income and asset information is available from CMS at http://www.cms.hhs.gov/researchers/demos/drugcoveragedemo.asp.

Benefit Level 2

• In 2004 $20 deductible; 15% coinsurance until you reach $1,695 in drug spending (including deductible), and then $2 for generic drugs and $5 for brand-name drugs.
  
• In 2005: $50 deductible; 15% coinsurance until you reach $5,100 in drug spending (including deductible), and then $2 for generic drugs and $5 for brand-name drugs.

Benefit Level 3

• In 2004: $0 deductible; $2 for generic drugs and $5 for brand-name drugs until you reach $1,695 in drug spending (including deductible), and then pay nothing.
  
• In 2005: $0 deductible; $2 for generic drugs and $5 for brand-name drugs until you reach $5,100 in drug spending (including deductible), and then pay nothing.

• In 2004: $0 deductible; $1 for generic drugs and $3 for brand-name drugs until you reach $1,695 in drug spending (including deductible), and then pay nothing.
  
• In 2005: $0 deductible; $1 for generic drugs and $3 for brand-name drugs until you reach $5,100 in drug spending (including deductible), and then pay nothing.

Benefit Level 5

• In 2004: $0 deductible and no cost-sharing required.
• In 2005: $0 deductible and no cost-sharing required.

Note that anyone with an income 50% above the poverty level does not qualify for low-income cost-sharing (in 2004, 50% above the poverty level is: $13,965 for Individuals & $18,735 for Couples in the 48 states; $17,445 for Individuals and $23,415 for Couples in Alaska; and $16,050 for Individuals & $21,540 for Couples in Hawaii).