Medicare program; catastrophic outpatient drug benefit--HCFA. Proposed rule

These proposed regulations would implement, in part, section 202 of the Medicare Catastrophic Coverage Act of 1988 (MCCA), which establishes a new catastrophic drug benefit under Medicare Part B. The new benefit would be added to the drug coverage already available under Medicare, which would continue largely unchanged. The MCCA provides for payment of a catastrophic level of beneficiary expenditures for "covered outpatient drugs". The payment aspect of this benefit will be implemented in separate regulations. The MCCA defines the items and services included as "covered outpatient drugs" to include coverage of outpatient prescription drugs on a much broader scope than is now available under Part B. These proposed regulations describe that new benefit. These regulations also describe the bases that HCFA would use to implement the statutory requirement for establishing standards for the prescribing of each "covered outpatient drug". These standards would be used to identify inappropriate drug prescribing and dispensing and adverse drug reactions and to educate physicians and pharmacists about them. They would not be used to define coverage or payment of covered outpatient drugs. The regulations also describe limits on the supply of a "covered outpatient drug" that Medicare would pay for, and reflect other related changes in Medicare created by MCCA.