As first reported in Politico, “the Partnership for Part D Access, a coalition of drug industry, disease and patient groups, sent a letter to HHS Secretary Alex Azar, asking him not to touch the Medicare Part D protected classes... The letter pushes back on the argument that removing certain drugs from protected class status could save money, saying that studies have shown the changes might lead to [d]rug savings but these savings will likely be offset by increases in spending in other parts of the health system, like hospitalizations.”
Fierce Healthcare: Axing protected drug classes in Medicare Part D may not substantially lower spending
Fierce Healthcare published an article covering a recent report from The Pew Charitable Trusts on Medicare’s six protected classes policy. The article, entitled “Report: Axing protected drug classes in Medicare Part D may not substantially lower spending,” notes that eliminating protected classes of medications may have a “limited financial payoff.” The article further details the use of medication management within the protected classes — correcting a common misnomer — by noting that “Part D plans do have some ability to restrict drugs in these classes… which could also impact how effectively eliminating the protected classes would cut down drug spending.”
An article in Inside Health Policy reports that eliminating the protected drug classes would not result in additional savings to the Medicare program. The article — citing a recent report by The Pew Charitable Trust on the protected classes policy — notes that while health plans would like to see more leverage over drug prices in the protected classes policy, a rollback of the policy would not save the program that much money due to factors such as strong generic drug competition and the ability of Part D plans to restrict drugs in the classes. The article also points out the widespread, bipartisan support that the six protected classes policy currently enjoys. “When CMS proposed eliminating three classes -- antidepressants, immunosuppressants and antipsychotics -- a 200-member coalition opposed the idea, as did Republicans and Democrats in both chambers. CMS subsequently backed off the proposal, then-CMS Administrator Marilyn Tavenner told Congress the agency didn’t plan to revisit it.”
Inside Health Policy: More Than 100 Patient Groups Warn Against Eliminating Protected Drug Classes In Part D
A new article in Inside Health Policy highlights a letter from the Partnership for Part D Access and 112 other patient organizations to HHS Secretary Tom Price warning the agency against making changes to Medicare’s ‘six protected classes’ policy. “More than 100 patient-advocate groups are warning against eliminating coverage protections for drugs in six therapeutic classes in an upcoming Part D proposed rule,” the letter states. “The contents of the proposal are unknown, but lobbyists for industry and patients are on edge because CMS plans to propose the first Part D rule since it pursued aggressive policy changes three years ago, according to the regulatory agenda... ‘These tools give Part D plans considerable flexibility to manage more expensive medications, as well as leverage to negotiate rebates with manufacturers,’ the Partnership for Part D Access wrote in a Sept. 8 letter to HHS Secretary Tom Price. Limiting access to drugs in protected classes would probably lower drug spending, but it would do so at the expense of higher hospital costs, the group says.”
The Partnership for Part D Access presented a letter today — cosigned by 111 individual patient advocacy organizations — to Department of Health and Human Services Secretary Tom Price, highlighting the importance to patients of the Medicare six protected classes policy. “The protected classes policy is essential for maintaining access to proper treatment for Medicare beneficiaries,” the letter states. “Patients with a condition in one of the protected classes have very complicated medical needs, and many of these patients must attempt a variety of therapies before coming to a decision with their physicians about what is the most appropriate treatment.”
A new study by economists Amanda Starc of Northwestern’s Kellogg School of Management and Robert Town of the University of Texas 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. In the study, the authors conclude that in covering drugs less generously, Part D plans end up costing traditional Medicare $475 million per year – a stat that does not account for other social costs, such as the inconvenience and suffering of beneficiaries who end up in the hospital. This study highlights the importance of Medicare’s six protected classes, which ensure that patients with the most complex conditions are guaranteed access to the full range of drugs under Medicare Part D – limiting future medical complications, hospitalizations, and additional costs to the Medicare program.
A recent article in Vox examines the challenges in diagnosing proper treatments for people with depression, namely the fact that not all treatments work for every patient. The author hones in on the frustrations depression patients face when they are prescribed medicine or therapy that is designed to help treat depression, but are ineffective to their specific needs, and show varying results from patient to patient due to the complexity of the disease itself. “No one thinks those two people have the same biological problem,” said Conor Liston, a research psychiatrist at Weill Cornell Medical College. “And yet those two people get the same label.” This article underscores the importance of the six protected classes, as proposals to limit access to certain medications under the Part D program which are not interchangable - such as antidepressants - would have a profound impact on the patients who benefit from having access to the full spectrum of treatment options.
The National Institutes of Health (NIH) recently published an article that highlights the necessity of unique treatment approaches for individuals battling depression. Depression, one of the most common mental disorders in the U.S., is not easily treated with “one-size-fits-all” therapy, the article explains, and is usually treated using antidepressant medications, therapy, or a combination. "It’s often a trial-and-error process to figure out which approaches will work best for each individual," the author notes. Researchers used information about early-life stressors and amygdala activity to predict the ability of certain antidepressants to treat symptoms of depression. Some correlation between physical differences in the amygdala and responsiveness to specific antidepressants emphasize the necessity of access to a range of antidepressants as part of individualized treatments.
An article in Bloomberg BNA highlights a recent letter from Senators Chuck Grassley (R-IA) and Sherrod Brown (D-OH) urging the Centers for Medicare and Medicaid Servcies to maintain the current "six protected classes" policy requring Part D plans to provide the full range of treatment options to especially vulnerable patients with certain medical conditions. “Despite Part D’s success and the effectiveness of the six protected classes policy, the Medicare Payment Advisory Commission (MedPAC) report released earlier this month included a recommendation to make changes to this popular policy,” Grassley and Brown wrote to acting CMS Administrator Andy Slavitt in a June 30 letter. The bipartisan letter was in response to Part D recommendations in MedPAC's June report to Congress that would permit drug plans to remove antidepressants and immunosuppressants for transplant rejection from protected classes requirements.
The Partnership for Part D Access, a broad-based coalition of health care stakeholders dedicated to preserving access to the full range of medications available under Medicare Part D, today applauded the bipartisan pair of Sens. Sherrod Brown (D-OH) and Chuck Grassley (R-IA) for their letter to the Centers for Medicare and Medicaid Services (CMS) urging the agency to maintain existing policy requiring Medicare prescription drug plans to carry six categories of specialized drugs for all participating beneficiaries. The letter, addressed to CMS Acting Administrator Andy Slavitt, outlined the senators’ “serious concerns” with the Medicare Payment Advisory Commission’s (MedPAC) recent proposal to remove two drug classes from the six currently protected, and recommended that CMS maintain the six protected classes policy “regardless of potential savings.”