WASHINGTON -- Rep. Benjamin L. Cardin, with fellow members of the Ways and Means Committee, today introduced the Medicare Chronic Disease Drug Benefit Act to provide Medicare fee-for-service beneficiaries with a prescription drug benefit for treatment of specific, chronic conditions that have been shown to be highly responsive to medications. The legislation builds on Rep. Cardin's Medicare Preventive Benefits Act, which was incorporated into the Balanced Budget Act of 1997.

Rep.Cardin's legislation provides outpatient drug coverage for the treatment of five chronic conditions – hypertension, major depression, diabetes, rheumatoid arthritis, and congestive and ischemic heart disease. Benefits are subject to a $250 annual deductible and co-payment of $0 for generics and 20% for non-generics. HCFA will coordinate the claims process through Pharmacy Benefit Managers.

Here are some of the facts about the chronic conditions that would be covered by the legislation:

• Hypertension is a major risk factor for heart disease, stroke and kidney failure, affecting nearly 40% of all Medicare beneficiaries. It is responsible for 32,000 inpatient admissions each year.
• Major Depression affects more than one million beneficiaries, more than any diagnosis except heart disease. Medicare spends $1.8 billion each year for 320,000 admissions to treat major depression. Treatment has been found to reduce overall health costs by 29%.
• Diabetes affects six million Americans over age 65. Diabetes is the leading cause of end-stage renal disease, and it costs Medicare $237 million each year to treat on an inpatient basis.
• Rheumatoid arthritis affects more than 1.75 million beneficiaries. The annual rate of hospitalization (34%) is nearly twice the rate for all Medicare beneficiaries (18.7%).
• Heart Disease is the largest single cause of death for the elderly. Drug therapy can reduce death rates for heart patients by 40%, but only half the people who could benefit from these drugs receive them. Medicare spends $7 billion annually for inpatient treatment of heart disease.

Studies show that seniors who have prescription drug coverage lead healthier lives. In a recent Medicare Beneficiary Survey, 40% of Medicare enrollees without drug coverage reported that their health is only fair or poor, compared to 23 percent of those who have drug coverage. But 35% of beneficiaries have no drug coverage to help pay for the 18 prescriptions each year they use on average.

"Seniors are highly dependent on drug therapy to maintain their health. By adding this benefit to basic Medicare, we can save lives, reduce hospitalizations, and decrease future Medicare expenditures," said Rep Cardin. Since the inception of Medicare HMOs, many plans have scaled back their drug coverage, and others have eliminated the benefit entirely. In addition, review of enrollment data shows that seniors suffering from chronic, debilitating diseases are less likely to enroll in Medicare+Choice HMOs.