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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