New Medicare Bill—enacted with veto override—provides benefits to lupus patients in Prescription Drug Program

Congress voted overwhelmingly July 16 to override a Presidential veto forcing enactment of HR 6331, the Medicare Improvements for Patients and Providers Act. The legislation makes changes favorable to lupus patients receiving benefits through the Medicare “Part D” prescription drug program.

The bill became law after the House voted 383 to 41 and the Senate voted 70 to 26 to override an earlier veto--in both cases far more votes than the two-thirds required by the U.S. Constitution.

This legislation was crafted over the last several months primarily to prevent a 10.6 percent cut in the payment rate to physicians who treat Medicare beneficiaries, the disabled and military personnel. The reimbursement reduction was scheduled by a previously enacted formula to go into effect on July 1, 2008. The bill prevented the cut and provided a 1.1 percent increase in the payment rate for 2009. Many physician groups said their members would not have been able to continue treating Medicare patients if the 10.6 percent reduction, and future scheduled reductions, had gone into effect. This bill is effective for 18 months, during which time many Members of Congress hope to develop a long-term solution to the Medicare physician reimbursement challenge.

The bill also contained changes to the Medicare Part D prescription drug program that may benefit lupus patients.

New provisions will make it easier for those on Medicare with conditions such as lupus to have access to medications not specifically approved for that indication—so-called “off-label” usage. Additionally, Part D health plans will now be required to cover most classes of drugs for chronic diseases, like lupus, through an expansion of the program’s “protected class” of drugs that all health plans must offer. Finally, the bill provides Part D coverage for benzodiazepines and barbiturates, which may be prescribed for lupus patients experiencing seizures or other conditions.

These three provisions are important gains for lupus patients covered under Medicare. You may wish to write your Member of Congress concerning his or her vote on this measure. To find out how they voted on the override legislation click here for members of the U.S. House of Representatives or here for members of the U.S. Senate.