[Congressional Record (Bound Edition), Volume 146 (2000), Part 18]
[Senate]
[Page 27210]
[From the U.S. Government Publishing Office, www.gpo.gov]



                BENEFITS IMPROVEMENT AND PROTECTION ACT

  Mr. BAUCUS. Among the most pressing issues facing American senior 
citizens and persons with disabilities is the need for coverage of 
prescription drugs under Medicare. While we in Congress continue to 
work to reach consensus on a Medicare prescription drug benefit, I 
applaud the bipartisan efforts of my colleagues to restore and preserve 
Medicare coverage for certain injectable drugs and biologicals that are 
crucial to seniors and persons with debilitating chronic illnesses. To 
this end the Act contains a tremendously important provision which 
amends Section 1861(s)(2) of the Social Security Act relating to 
coverage under Medicare Part B of certain drugs and biologicals 
administered incident to a physician's professional service. Because it 
is expected that the Act will be passed without any accompanying 
Committee Report language, and due to its importance to thousands of 
citizens, I rise to explain this statutory language.
  The Medicare Carrier Manual specifies that a drug or biological is 
covered under this provision if it is ``usually'' not self-
administered. Under this standard, Medicare for many years covered 
drugs and biological products administered by physicians in their 
offices and in other outpatient settings. In August 1997, however, the 
Health Care Financing Administration issued a memorandum that had the 
effect of eliminating coverage for certain products that could be self-
administered. This changed policy interpretation resulted in thousands 
of patients who until that time had had coverage for drugs or 
biologicals for their illnesses, including intramuscular treatments for 
multiple sclerosis, being denied coverage for these same drugs and 
biologicals. At a time when the Congress and the Administration are 
seeking to expand Medicare prescription drug coverage, this HCFA policy 
has led to a reduction in coverage of many treatments.
  The Act's language clarifies the Medicare reimbursement policy to 
ensure that HCFA and its contractors will reimburse physicians and 
hospitals for injectable drugs and biologicals for illnesses such as 
multiple sclerosis and various types of cancer as they had been 
reimbursed prior to the 1997 memorandum. The new statutory language 
contained in the Act requires coverage of ``drugs and biologicals which 
are not usually self-administered by the patient,'' thus restoring the 
coverage policy that was in effect prior to the August 1997 HCFA 
memorandum. In carrying out this provision, HCFA should not narrowly 
define the word ``usually.'' Nor should HCFA make unsupported 
determinations that a drug or biological is usually self-administered. 
In addition, HCFA should assume, as it did for many years, that 
Medicare patients do not usually administer injections or infusions to 
themselves, while oral medications usually are self-administered. HCFA 
should also continue to take into account the circumstances under which 
the drug or biological is being administered. For example, products 
that are administered in emergencies should be covered even though 
self-administration is the usual method of administration, in a non-
emergency situation.
  I believe that to implement Congressional intent on this provision, 
HCFA must promptly issue a memorandum to inform its contractors (e.g. 
carriers and intermediaries) of the change in the law.
  I commend the efforts of the bipartisan sponsors of this provision 
for correctly clarifying the intent of the Medicare reimbursement 
coverage policy for injectable drugs and biologicals. This issue is of 
vital importance to thousands of our citizens that are afflicted with 
debilitating illness such as multiple sclerosis. As Congress and the 
nation continue to engage in a discussion on expanding prescription 
drug coverage under Medicare, this is an important step to provide our 
seniors and persons with disabilities with the life-saving prescription 
drugs and biologicals that they deserve. I look forward to continue 
working with the Administration and HCFA to ensure that our seniors and 
persons with disabilities receive coverage for injectable drugs and 
biologicals.

                          ____________________