Bush administration officials, who announced the program on June 24, had expected that they could be selected to participate in order to stay within the program's budget (Pear, New York Times, 9/11).

The 18-month program, which is part of the new Medicare law, has a budget of $500 million and will continue until 2006, when the new prescription drug benefit takes effect. Under the program, Medicare will pay for some 25 at-home treatments for diseases such as cancer, multiple sclerosis and rheumatoid arthritis. The program will include 11 cancer medications, three rheumatoid arthritis treatments and medications for the bone disorder Paget's Disease and hepatitis C (Kaiser Daily Health Policy Report, 6/25).

Only 6,364 Medicare beneficiaries to date have applied to participate in the program. CMS officials expected to enroll 5,000 Medicare beneficiaries in August but only received about 3,700 applications. The agency enrolled almost all of those applicants in the program (Sherman, AP/Philadelphia Inquirer, 9/12). CMS Administrator Mark McClellan said the agency has received about 1,000 applications per week for the program (New York Times, 9/11).

CMS has established a new Sept. 30 deadline for Medicare beneficiaries to submit applications to participate in the program, but McClellan has said that the program would continue to accept applications after the deadline has passed (AP/Philadelphia Inquirer, 9/12).

In the event that fewer than 50,000 Medicare beneficiaries apply to participate in the program, CMS will enroll all eligible applicants unless the total estimated cost of the program would exceed the $500 million limit established by Congress (New York Times, 9/11).

CMS has "dropped all mention of a lottery, which some critics found distasteful in connection with information involving a serious illness," the AP/Inquirer reports.

Reaction

According to patient advocates and physicians, the use of the word "lottery," low levels of publicity for the program and the "intimidating" 12-page application may have contributed to the low number of Medicare beneficiaries who have applied to participate, the AP/Inquirer reports (AP/Philadelphia Inquirer, 9/12).

Rep. Deborah Pryce (R-Ohio), who helped develop the program, said that she is "truly surprised" that more Medicare beneficiaries have not applied to participate, adding, "We need to do a better job of educating patients and physicians, who are just not getting their patients signed up as we hoped they would."

Ellen Stovall, president of the National Coalition for Cancer Survivorship, said, "I am totally befuddled. We worried that people would storm the barricades and some would be turned away. But just the opposite is happening." Consumer advocacy groups said that CMS officials should "analyze the experience closely to make sure more people sign up for the regular drug benefits," the Times reports (New York Times, 9/11).