Medicare Now Covers Defibrillators For Some Heart Patients;
Will Pay For Sex-Aid Drugs Under New Rx Program

Changes in Medicare coverage have been in the news recently, in one case expanding eligibility for defibrillators, which will help some heart patients, in another making pills like Viagra available under prescription drug coverage when that starts next January, and in a third, allowing employers to collect huge subsidies for providing lesser drug benefits than had been expected.

The implantable cardioverter defibrillator is a device about the size of a stopwatch which is implanted under the skin and detects irregularities in heart rhythm. When dangerous heart flutters occur, the device sends shocks to the heart which makes the heart beat normally again.

About 450,000 people in the United States die each year from sudden cardiac arrest. The defibrillator can help to save people in this situation.

The Centers for Medicare and Medicaid Services announced the new benefit about two weeks ago, giving hope to about a half million beneficiaries with that particular heart ailment.

However, to get the device, a person must agree to release information about their case to a database shared by hospitals. The data could help the medical community to determine who would be most helped by the device and the information will be held strictly confidential.

Medicare has already been making the device available for patients who have already had possibly fatal arrhythmias. Coverage has been expanded partly because it is felt that it can save the lives of people who are at risk of suffering such an experience.

The coverage for men who suffer from erectile dysfunction was revealed recently when the final rules covering the new Medicare changes that will take effect next January were issued.

Subsequently, a spokesman for Medicare explained that the coverage was based on the policy that prescription drugs that are medically necessary and have been approved by the federal Food and Drug Administration have to be covered under the new plan. It would include drugs such as Viagra, Levitra and Cialis.

However, opposition to the rule has arisen in Congress. The New York Times reported that Congressmember Steve King, a Republican from Iowa, plans to introduce a bill to prohibit Medicare payment for the drugs in question.

King argues that we promote abstinence among young people so how can we pay for “sex enhancing” drugs for seniors. There’s just so much money available for covering prescription drugs, so in paying for Viagra or any of the others, you may be, in effect, taking money away for a life-saving drug, King reasoned.

The rules covering subsidies to employers for providing prescription drugs to retirees who previously worked for them were also spelled out in the Federal Register.

In explaining this rule, Bush administration officials said the retiree benefits provided by an employer are different than those provided under Medicare. They said many employers will be able to withhold Medicare’s catastrophic coverage, which helps those with the highest drug costs and covers about $300 of the $1,200 considered to be the standard benefit under the drug prescription law.

It was also explained that the favorable interpretation of employer coverage would attract more employers into the program, which is an optional choice for them.

If a retiree felt he would be better off getting his drug coverage under Medicare rather than through his employer’s health care coverage, that option would be available to him. Employers are the largest source of drug coverage presently, despite the fact that over the past decade many have been cutting health benefits for their retirees. It was because of this trend that the Bush administration offered employers subsidies if they continue to provide prescription drug benefits after the program starts next January.

MEETING: AARP Chapter No. 2889 will meet next Wednesday at 12:30 p.m. at the First Presbyterian Church of Newtown, 54-05 Seabury St., Elmhurst. Music by Tony Teller is on the program.