For Immediate Release Office of the
Press Secretary July 11, 2002
Fact Sheet: President Renews Call for Prescription Drug
Coverage in Medicare
President Renews Call for Prescription Drug Coverage in Medicare
New HHS Study Highlights Potential for Medical Breakthroughs
TODAY'S PRESIDENTIAL ACTION
In a speech and his visit to the University of Minnesota Medical
College, President Bush renewed his call for congressional action to
provide prescription drug coverage and improve Medicare for seniors
and persons with disabilities. The President noted that the House of
Representatives took an important step toward providing affordable
drug coverage by passing legislation last month, and he urged quick
action in the Senate on his framework for strengthening Medicare.
The President was accompanied by HHS Secretary Tommy Thompson,
who released a new HHS report on Securing the Benefits of Innovation
for America's Seniors. The report presents a detailed analysis of
the major improvements in health resulting from new breakthroughs in
prescription drugs. It also highlights the differences in drug
coverage between the private drug insurance plans in the United
States and the government-controlled plans in many other countries,
and the health consequences of restricted access to new drug
treatments in government-controlled plans.
BACKGROUND ON THE PRESIDENT'S FRAMEWORK FOR PRESCRIPTION DRUG
LEGISLATION
The President has proposed a comprehensive framework for
strengthening Medicare that includes guaranteed access to an
affordable Medicare prescription drug benefit for all seniors.
The drug benefit would allow seniors to strengthen the private
health insurance coverage that helps well over half of seniors
today-- seniors would not see their coverage replaced by a
one-size-fits-all government plan.
All seniors would have choices of drug coverage, to enable them
to get the coverage they prefer -- no senior would be forced to
accept just one or two "options" in which the government controls
which drugs are covered, as under some prescription drug proposals.
Seniors would have access to other modern benefits, like those
provided in the Evercare plan and other private Medicare+Choice
plans in the Minneapolis area, which help them work with their
doctors to stay healthy and reduce their drug costs. For example,
Evercare provides "disease management" services for seniors with
multiple complex illnesses and their families, reducing the number
of prescriptions they have to take and reducing their health care
costs -- all while achieving patient and family satisfaction of 95
percent.
Seniors would get help now -- they would not have to wait for
relief for several more years while the full Medicare drug benefit
is set up.
The President has proposed a Medicare-endorsed drug card,
supported by AARP and other senior and medical groups. All seniors
will be able to use their purchasing power to get lower prices from
drug manufacturers.
The President has proposed Federal funding beginning next year
to provide prescription drug assistance to low-income Medicare
beneficiaries, through existing state programs or the Medicare drug
card. Up to 3 million seniors who do not have drug coverage now
would get help.
The President has proposed new Medigap options that provide more
affordable drug coverage, and fair payments for Medicare+Choice
plans so they can continue to provide drug coverage and other modern
benefits for seniors.
All of these proposals for immediate help are reflected in the
House-passed Medicare bill.
These proposals are part of a comprehensive framework that would
give seniors more reliable and affordable options for health care
coverage, that would keep Medicare's benefits financially secure for
the Baby Boom, and that would allow seniors who wish to do so to
keep the coverage they have with no changes.
Most importantly, all seniors should have access to the best
breakthrough drug treatments available today, and quick access to
drug breakthroughs that are in the pipeline of research and
development. The HHS report issued today shows the way to make that
happen.
HIGHLIGHTS OF THE NEW HHS REPORT, SECURING THE BENEFITS OF
INNOVATION FOR AMERICA'S SENIORS, RELEASED TODAY BY HHS SECRETARY
TOMMY THOMPSON
The HHS report includes a detailed review of recent
breakthroughs in drug treatments for the following diseases: cancer,
osteoporosis and hip fractures, asthma, arthritis, high cholesterol,
heart disease, stroke, enlarged prostate, depression, Alzheimer's
disease, diabetes, and migraines.
For all of these diseases, the HHS report presents evidence on
significant improvements in the health of older Americans that have
occurred because of the drug breakthroughs -- enabling millions of
seniors to live longer and more enjoyable and productive lives.
For all of these diseases, the HHS report describes new drugs in
the pipeline of research and development that can provide even
greater improvements in health.
But the HHS report also shows that access to these new
treatments is not guaranteed: for all of these diseases, countries
with government-run prescription drug coverage programs have limited
costs by restricting access to new drugs.
Coverage of new drugs is delayed while
government-appointed committees make decisions about which patients,
if any, should have access to the drugs.
Coverage of new drugs is restricted to selected patients
that meet criteria imposed by the government drug plan.
Coverage of new drugs is denied if new drugs don't make
the government formulary, or covered drug list.
And patients who could benefit from the new drugs cannot
choose to get coverage from another plan that would better meet
their needs.
In contrast, new breakthrough drugs are generally covered
quickly by private insurance plans in the United States. As a
result, Americans have far greater availability and use of
life-saving and life-improving new drugs.
U.S.-produced drugs account for the largest share of drug
innovation worldwide: In 1999, drugs developed and produced by
American companies accounted for more than 80 percent of global
sales of the world's top 15 drugs.
In the late 1990s, U.S. drugs accounted for almost 70 percent of
the worldwide sales of new drugs.
A recent report for the European Commission noted that Europe is
falling behind in drug research and development, and concluded that
governments should
converge on a higher reliance on innovative management methods
and on competitive mechanisms, moving away from schemes excessively
based on administrative decisions and bureaucratic structures/rules
in the regulation in the market."
With all of the new breakthrough drugs in the pipeline, now
is not the time for Medicare to create a drug benefit that would
limit the development and availability of new drugs in the United
States.
According to the HHS report, when Medicare adds a prescription
drug benefit, it should guarantee access to up-to-date coverage of
breakthrough drugs. To control drug costs, seniors should not be
required to join a one-size-fits-all government-run drug plan with
delays, controls, and restrictions on coverage that result in worse
health. Instead, seniors should be allowed to choose the private
coverage that is best for them -- and to keep costs down through
competition, innovation, and preventing medical complications.
Approaches to reducing drug prices and drug costs that do not
prevent patients from getting access to needed new drugs include:
group purchasing arrangements to get volume discounts, "disease
management" and "case management" programs which help patients and
doctors coordinate care and get the most effective treatment for
complex chronic diseases, and competition among health plans to
allow patients to choose the coverage that best meets their needs.
The HHS report concludes that "These steps will help keep drugs
available and affordable without reducing access to valuable new
treatments and discouraging innovation just at the time when the
potential for innovation is greatest."
For the complete HHS report, go to http://aspe.hhs.gov/health/reports/medicalinnovation.
Some examples of life-saving and life-improving
breakthrough drugs that are often not available in government-run
drug plans, but that are generally covered by private drug plans in
the United States:
Cancer: Gleevec, the breakthrough treatment that prevents
complications and death from some forms of leukemia, is not covered
in New Zealand and is covered in England only after patients reach
the advanced stage of the disease. Targretin (for certain
lymphomas), Interleukin-2 (for kidney cancer), and Rituxan (for
lymphomas) are not covered at all or covered only with significant
patient restrictions in Canadian provinces like Ontario.
Alzheimer's Disease: Aricept, which improves brain
function in many patients with mild to moderate dementia, is not
covered in Quebec and is restricted in Ontario.
Arthritis: Enbrel, which enables many patients with
rheumatoid arthritis to return to a normal life, is not available in
Japan and not covered in Ontario or New Zealand. Celebrex and Vioxx,
which have fewer side effects in many seniors than other pain
relievers for arthritis, are restricted or not available in
Australia, New Zealand, and many Canadian provinces.
Asthma: Singulair, a new treatment for asthma that does
not have the side effects of inhaled corticosteroids, is not covered
for adults and seniors in Australia, Belgium, Finland, and many
Canadian provinces.
Depression: The first "SSRI" drug (a drug class that
includes such widely used drugs as Prozac, Zoloft, Paxil) was not
approved for coverage in Japan until 1999 -- twelve years after such
drugs were first covered in the US. In Canada, Wellbutrin is only
covered for patients who are "unresponsive" to other treatments, and
even then only through a special government program.
Diabetes: Avandia, a new oral drug that helps many
diabetic patients avoid insulin injections, is not covered in
Ontario or New Zealand.
Enlarged prostate: Proscar, which prevents the common
complications of prostate enlargement in older men, is not covered
in Ontario.
Gastrointestinal (stomach) symptoms and ulcers: Coverage
of Prilosec, the #1 prescription drug in the United States, is
limited to special conditions and time limits in Canada, and prior
approval is required.
High blood pressure: Cozaar, Hyzaar, Univasc, Sular,
Diovan, and other new drug treatments are not covered or covered on
a restricted basis (for example, only in patients who have "proven"
to government standards that they cannot tolerate other treatments)
in Canada.
High cholesterol: Lipitor, Mevacor, and Pravachol are not
on the "formulary" (covered drug list) or are covered on a very
restricted basis in Australia or New Zealand.
Infant respiratory distress: Curosurf was first covered
in the US in 1999, and is still not approved for use by the Canadian
government.
Insomnia: Sonata, a drug that does not have the side
effects of benzodiazepines like Valium, was first covered in the US
in 1999 and is still not approved for use by the Canadian
government.
Osteoporosis and hip fractures: New "bisphosponate" drugs
like Fosamax strengthen bones and prevent hip and back fractures in
older women without the often serious complications of hormone
therapy. But in many Canadian provinces, Australia, Italy, France,
Belgium, and other countries, Fosamax is only covered in very severe
cases of osteoporosis, or only after a patient has had a bone
fracture that the drug is designed to prevent.
The Appendix of the HHS Report, available at http://aspe.hhs.gov/health/reports/medicalinnovation,
includes many more examples of coverage restrictions and
prohibitions in government-controlled prescription drug plans.
For more information on the President's initiatives please visit
www.whitehouse.gov
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