This post originally appeared in Inside Health Policy on February 12, 2019.
HHS may stop the insurance industry practice of making seniors fail on drugs that have already failed for them when switching to a new Medicare drug plan, HHS Secretary Alex Azar told the American Medical Association Tuesday (Feb. 12).The practice is known as step therapy, though patient advocates often call it fail first. Azar learned of that application of the practice in meetings with patients and doctors who are urging against a separate HHS proposal to use step therapy more broadly in six protected drug classes.
This post originally appeared in Modern Healthcare on February 12, 2019.
HHS Secretary Alex Azar said the agency is exploring cracking down on a practice insurance plans use to make a patient start over on step therapy if they switch plans. Azar's comments before the American Medical Association's Advocacy Conference in Washington on Tuesday comes as the agency is proposing allowing Medicare Advantage plans to apply step therapy and prior authorization to drugs sold in Medicare Part B and Part D. The practice has opposition from some patient groups who fear that the tools hinder patient access.
The Partnership for Part D Access applauded HHS Secretary Alex Azar for his remarks in a speech today before the American Medical Association (AMA) in which he acknowledged the dangers inherent in requiring step therapy for patients who are already stabilized on an effective regimen of medications. Interestingly, his remarks seemed to run counter to his agency’s current proposal to weaken Medicare’s successful “six protected classes” policy. Given today’s statement, the Partnership urges the Secretary to abandon the administration’s proposal, which countless stakeholders would agree is “penny-wise and pound-foolish.”
This post originally appeared in Roll Call on February 5, 2019.
President Donald Trump’s plan to eliminate HIV transmission in the United States by 2030, which he announced Tuesday night, would be an ambitious goal that would require his administration to reverse course on a number of policies that potentially hinder access to HIV/AIDS care. “Together, we will defeat AIDS in America,” Trump said in his State of the Union address. He said that his budget will “ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”
Leading stakeholders within the HIV/AIDS community recently penned op-eds outlining the detrimental effects that the Trump administration's proposed drug pricing rule would have on patients. The authors astutely note that a "one-size-fits-all" approach is the wrong solution given the complexity of the disease as well as the individual needs of HIV patients. Stakeholders also emphasized that reliance on step therapy and prior authorization would create additional barriers to access for lifesaving treatments.
This op-ed originally appeared in The Hill on February 4, 2019.
When then-President Lyndon Johnson signed Medicare into law in the summer of 1965, he declared, “No longer will older Americans be denied the healing miracle of modern medicine.”Johnson’s pledge was as prophetic as it was audacious: Medicare fundamentally transformed health care, giving seniors unprecedented access to the medicine and services they need to live longer, healthier lives.That promise now hangs in the balance. The Trump administration is pushing policies that threaten to undermine Medicare coverage for many of America’s most vulnerable seniors and people with disabilities. The worst of these misguided proposals could kill people. This might sound hyperbolic, but it’s not.
This post originally appeared in the Washington Examiner on January 31, 2019. .
Outside groups prepare to fight Trump drug pricing proposal. Outside groups involved with fighting HIV, epilepsy, and serious mental illness are prepared to battle the Trump administration on a plan to change Medicare Part D, the portion of the program that covers prescription drugs. The administration has proposed making changes to what are known as the “six protected classes” of drugs, which allow certain patients with serious health conditions to receive any drug that their doctor determines is best to treat them.
This post originally appeared in Politico Pro on January 29, 2019.
Industry and patient groups alike are pushing back on a CMS proposal to give Medicare Part D and Medicare Advantage plans power to limit coverage of “protected class” medicines in a bid to lower government spending. The deadline to submit comment on CMS’s proposal, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, was Jan. 25 and hundreds rolled in. While the proposed rule lays out a number of strategies, the top item would give plans broader negotiating tools — including step therapy and prior authorization — for anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals and immunosuppressants.
This post initially appeared in The Buffalo News on January 22, 2019.
The Trump administration is poised to undermine seniors’ access to lifesaving medications.It recently proposed a rule that would weaken patient protections within Medicare’s “Part D” prescription drug benefit. By law, Part D drug plans are required to cover all drugs in six “protected classes” of medicines. This requirement ensures that seniors and people with disabilities have widespread access to drugs used to treat cancer, depression, HIV and more.
Chuck Ingoglia, Executive Director of the Partnership for Part D Access, delivered the following remarks at the Medicare Payment Advisory Commission's (MedPAC's) January 17, 2019 public meeting.
In light of the Commission’s work on Medicare Part D, the Partnership thought it would be helpful to share an update on a policy you’ve touched on in the past: Medicare’s six protected classes. This issue is especially relevant today, as the Commission’s 2016 recommendation on the protected classes has been cited in the context of a proposed rule that was recently released by CMS.