Special Notices

Medicare Replacement Drug Demonstration Project

Coverage of Tarceva added for Non-small cell lung cancer

As a patient with non-small cell lung cancer, your doctor may prescribe Iressa or Tarceva for you.  If you’re concerned about the costs of these drugs, there may be help from Medicare to pay for these medications.  Please read the questions below to see if you may qualify for this program:

• Has your healthcare provider prescribed or plan to prescribe Iressa or Tarceva for you?  You don’t currently have to take one of these medications.
• Do you have or are you eligible for Medicare Part A and Medicare Part B?
• Is Medicare your first and primary health insurance?
• Do you live in one of the 50 states or the District of Columbia?

If you answer “yes,” to these four questions, the Medicare Program called The Medicare Replacement Drug Demonstration may help you.  Depending on your income, you could save between 58 percent and 98 percent of the cost of these drugs.  If you need help with these questions, please call Medicare. The phone number is below.

Why does this program exist?
The Medicare Replacement Drug Demonstration program covers medications that “replace” selected drugs given in the doctor’s office with drugs taken at home. Medicare created this demonstration program now to help them better understand patient needs before their broader prescription drug benefit program begins in 2006. 

If you think you might be interested, we encourage you to get further information and talk with your doctor about whether or not changing from in-office chemotherapy to one of these medications is right for you.  Also ask your doctor about the costs, that is, if the dollars you pay for these in-home medications would change your out of pocket costs.

Get further information about this program and/or help filling out the application by calling :

• Medicare representatives at 1-866-563-5386 between 8:00 a.m. and 7:30 p.m. Eastern Time, Monday through Friday OR
• Patient Advocate Foundation representatives at 1-800-532-5274 between 8:00 a.m. and 5:30 p.m. EST and talk to someone about how this program may help you.

Both organizations are prepared to answer your questions and/or help walk you through the application process.  Or, if you prefer, you can download the PDF application form from Medicare and fill it out yourself.

For more information on the web:

• http://www.cms.hhs.gov/researchers/demos/drugcoveragedemo.asp
• http://www.patientadvocate.org/
• http://www.medicarerights.org/maincontentrxdemo.html
• http://seniorhealth.about.com/od/medicare/a/medi_drug_demo.htm