Protecting access to treatments for Medicare patients with the most complex conditions.
The 'Six Protected Classes' Policy:
Part D's Essential Patient Safeguard
Part D's Essential Patient Safeguard
Report: High Rates of Low-Cost Generics in Protected Classes
The Partnership for Part D Access has released a new analysis prepared by Avalere Health which finds Medicare’s existing protected classes policy is working as intended for Medicare beneficiaries with some of the most complex health conditions: cancer, HIV, transplant recipients, epilepsy, and mental illness among others. Specifically, the findings clearly demonstrate that Medicare drug plans are aggressively employing utilization management and other tools across the six protected classes — meaning patients are directed to use lower-costing medications whenever appropriate.
Partnership Submits Letter on HHS Drug Pricing RFI
Despite widespread bipartisan backing and a history of longstanding support from patients, a new proposal designed to address prescription drug prices could potentially undermine Medicare's vital 'protected classes' policy. As an essential patient safeguard in Part D, the protected classes stand as a guarantee that patients with the most complex conditions will have access to the full spectrum of medications under Part D. In a letter to the Department of Health and Human Services, the Partnership outlines the overwhelming evidence that reinforces the importance of the ‘six protected classes’ as they currently stand.
What You Need to Know About the Six Protected Classes
Every day, millions of Americans rely upon their Medicare drug benefit to help manage their health conditions, including mental illness, organ transplants, epilepsy, Parkinson’s Disease, lupus, cancer and HIV. Because patients with these illnesses react differently to different medicines, access to the full range of effective medications is a crucial component of successful treatment and recovery. Medicare’s “Six Protected Class” policy has long stood as a guarantee to patients that their access to all available medications would never be in doubt.
In a letter to the Department for Health and Human Services (HHS), stakeholders encourage the agency to retain the Medicare Part D protected classes policy, touting its overwhelming success in providing access to certain medications for the most vulnerable beneficiaries within Medicare.
Study: Medications in ‘Protected Classes’ Are Heavily Managed Under Medicare
A new study published in the American Journal of Managed Care concludes that medications in Medicare’s six protected classes are the most likely to be subject to various utilization management techniques — such as step therapy or prior authorization — that are employed by Part D plans.
Proposed Drug Pricing Reforms Could Harm Patient Access, Increased Hospitalizations
Partnership for Part D Access expresses concern with a new Medicare drug pricing proposal that would ultimately harm patients with the most complex conditions. The proposed rule would weaken Medicare’s “protected classes” policy, which was created to ensure patients with the most challenging medical conditions have access to the full range of treatment options under Medicare Part D. The proposal will be subject to a 60-day public comment period before the administration determines whether to move forward with finalizing these changes.
Pew: Changes to 'Six Protected Classes' Unlikely to Produce Savings
The Pew Charitable Trusts concludes in a new report
that savings from the elimination of protected classes may be minimal within the context of total program spending. The authors conclude that “lack of adequate access to medications can in some circumstances increase costs to other Medicare programs through increased hospitalizations from complications..."
Study: ‘Profit-Maximizing’ Part D Plans Cause Increases in Overall Medicare Spending
A recent study highlights how “profit-maximizing” Part D plans are incentivized to limit benefits or increase costs for Medicare beneficiaries because they are not responsible for costs incurred by other parts of the Medicare (ex. hospitalizations). As detailed in the study, Part D plans are motivated by incentives that are sometimes counter to the best interests of patients; they are explicitly incentivized to reduce drug spending, while they have no financial responsibility for the holistic health of the patient.
Leading stakeholders from across the ideological spectrum have offered vocal support for Medicare's six protected classes policy. From the Manhattan Institute to the Medicare Rights Center — and everyone in between — leading policymakers and health care advocates have consistently spoken out in support of the protected classes.