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Medicare is implementing
a demonstration program which will
provide a special "bridge" benefit. The
program will make approved drugs
available to some beneficiaries before
the new Medicare drug benefit becomes
available in 2006. When Medicare first
began, only drugs that were administered
in a physician’s office had been covered
under Medicare Part B. Now, eligible
homebound osteoporosis patients may be
able to receive coverage for nasal
calcitonin, risedronate, raloxifene or
alendronate. Since its
beginning, the National Osteoporosis
Foundation has been active in supporting
expansion of Medicare coverage for
individuals with osteoporosis.
The Medicare Replacement Drug
Demonstration is a time-limited Medicare
demonstration that will cover certain
drugs before Medicare’s prescription
drug program begins in 2006. These drugs
include medications for various diseases
including osteoporosis. A limited number
of participants will be accepted into
the demonstration program so early
enrollment is encouraged to receive this
benefit.
This demonstration will provide
assistance with the cost of medications
to some beneficiaries as early as Sept.
1, 2004. Participation in the
demonstration is completely voluntary.
This demonstration may not cover all the
medications prescribed for a condition,
but those beneficiaries who qualify will
find they can save money by
participating.
For more information on how to enroll
please visit the federal government’s
websites for further details and an
application. You may also receive an
application by calling (866) 563-5386 or
(866) 563-5387 for TTY users. In
addition, a list of frequently asked
questions and responses is listed below.
www.cms.hhs.gov
www.medicare.gov
Frequently Asked Questions
1. Who is sponsoring the project?
The Centers for Medicare & Medicaid
Services (CMS) is sponsoring the
project. CMS is the federal agency in
the Department of Health and Human
Services responsible for the Medicare
program.
2. Where is the project being
implemented?
This project is available to Medicare
beneficiaries in the 50 United States
and the District of Columbia.
3. How do I apply for this
demonstration?
You may have an application package
mailed to you by calling (866) 563-5386.
TTY users should call (866)-563-5387.
Or, you can go to website at
www.medicare.gov
You should send your completed
application to the following address:
Medicare Replacement Drug Demonstration
c/o TrailBlazer Health Enterprises,
L.L.C.
P.O. Box 5136
Timonium, MD 21094
If you have any questions about the
application form or need assistance
completing it, please call the telephone
numbers above between 8:00 am and 7:30
pm Eastern Time Monday through Friday.
4. When will the demonstration start?
You can send in your application anytime
from July 6, 2004 through September 30,
2004. Your coverage will begin October
18, 2004. If you send in your a
completed application by August 16,
2004, you may be part of an early
selection process. This means your
coverage would begin by September 1,
2004. Applications will continue to be
accepted after September 30, 2004 to the
extent additional enrollment slots are
still available.
5. How long will the demonstration last?
The demonstration will end on December
31, 2005. If you want to continue to get
these Medicare-covered drugs after this
date, you will have to join a Medicare
prescription drug plan in 2006.
6. Is there a limit to the number of
people who can participate in the
demonstration?
Yes. No more than 50,000 people with
Medicare will be able to join this
demonstration. . If more than 50,000
people apply for this demonstration,
participants will be randomly selected.
All applications received by September
30, 2004 will have an equal chance of
being chosen to participate in this
demonstration. . If you aren’t selected,
your name will be placed on a waiting
list in case additional slots become
available.
7. How do I know if I am eligible for
this demonstration?
In order to be eligible for this
demonstration, you must meet the
following criteria:
You must have or be able
to get Medicare Part A, and have
Medicare Part B
Medicare must pay first
for your healthcare services (called the
primary payer)
You must live in one of
the 50 states or the District of
Columbia
You must have a signed
document from your doctor explaining
that you need one of the drugs covered
under this demonstration for your health
condition.
You currently don’t need
to be taking any of the drugs covered
under this demonstration to qualify. If
you have any questions about whether
these drugs may be right for you, you
should talk to your doctor.
You don’t have any other
insurance that has comprehensive drug
coverage (such as Medicaid, an employer
or union group health plan, or TRICARE)
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