Some 25,000 cancer patients on Medicare will soon be able to get coverage for life-saving chemotherapy drugs that are not currently paid for by the agency. The Centers for Medicare and Medicaid Services is beginning a process to select patients who will receive the drug coverage more than a year before it becomes available to all Medicare beneficiaries in January, 2006.

The American Cancer Society lobbied for the transitional coverage -- called a demonstration program -- as part of the Medicare reform law passed last year. "It's definitely a victory," said Wendy Selig, vice president of legislative affairs for ACS. "While it's not going to meet every need of every person out there, it's certainly going to make a difference to those 25,000 people."

QUICK REFERENCE: Medicare Process for Coverage of Oral Cancer Drugs Who may apply Which drugs are covered Costs to patients Where to get an application September 30, 2004 deadline By phone: 1-866-563-5386, Mon.-Fri., 8AM-7:30PM (EST)

Medicare currently offers coverage of chemotherapy drugs that are given in a doctor's office, intravenously or by injection, as well as pill versions of these drugs. But many newer drugs are available only as pills that a patient can take at home; these drugs typically have not been covered. Because many of these medications are very expensive, many Medicare beneficiaries cannot afford them on their own.

The new demonstration project will make 11 of these drugs available as early as September, at substantially lower prices:

• 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

According to the Department of Health and Human Services, most patients can expect to save 55% to 90% off the cost of these drugs. People with lower incomes will save even more. Gleevec, for instance, retails for nearly $46,000 a year. Under the demonstration program, HHS said, the drug will cost about $5,298 for most beneficiaries, a savings of 88%. Low income patients may be charged only $638, while those closest to the federal poverty level will pay as little as $60.

More than a dozen non-cancer drugs will also be discounted under the program for 25,000 other beneficiaries with serious diseases including multiple sclerosis, rheumatoid arthritis, and hepatitis C.

To qualify for the program, a patient must have Medicare Part A and B, have Medicare as their primary insurer, and not have drug coverage through another plan. Only people in the 50 US states and the District of Columbia may apply.

Patients can begin applying for benefits on July 6. They must submit the official application form, and a certification from their doctor confirming their need for a specific drug. Recipients will be randomly selected by a computer program until the program limit is reached.

Applications will be accepted until September 30, 2004. People who get their applications in by August 16, however, will be part of an early selection process that could get them coverage sooner -- by September 1.

The people chosen to receive the drug benefit will be notified in writing and will receive a special drug discount card (a different card than those already available to all beneficiaries for other drug purchases) that can be used at some local pharmacies or through a mail order service.

The demonstration program will run through December 31, 2005; after that date, all Medicare beneficiaries will be eligible to enroll in the drug coverage plan.

Editor's note: The drug Temozolomide (Temodar) for anaplastic astrocytoma is no longer covered under the Medicare demonstration program. Although originally part of the program, it has been removed because it is already covered under Medicare Part B. Coverage for Mesna was added in August 2004.