On their final day in office, the outgoing Trump Administration, through the Centers for Medicare and Medicaid Services (CMS), announced a new proposal that would undermine key patient protections in Medicare's prescription drug program. Indeed, policy outlined in a new Request for Applications (fact sheet) would allow Medicare Part D plans that participate in the third year of the Center for Medicare and Medicaid Innovation’s (CMMI) Part D Payment Modernization (PDM) Model to limit the drugs they cover, including denying patients access medications used to manage complex conditions such as cancer, mental illness, HIV-AIDS, epilepsy, Parkinson’s, and organ transplantation. The Biden Administration will have authority to determine whether the new policy is ultimately implemented. 

This post originally appeared in Fierce Healthcare on July 16, 2019. 

A new study found a Trump administration proposal to rein in prices on certain drugs under Medicare Part D would have made drugs less accessible to patients. The study, published Tuesday in the Journal of the American Medical Association, explored price hikes over a five-year span for products in protected classes. Medicare Part D requires plans to add to their formularies products in six classes that include antidepressants, antipsychotics and immunosuppressants.

This post originally appeared in STAT News on May 16, 2019 

WASHINGTON — The Trump administration is backing off a controversial proposal to chip away at existing safeguards that require Medicare to cover all drugs for conditions like depression and AIDS. The initial proposal, which would have allowed private Medicare plans to refuse to pay for certain drugs for chronic conditions that spiked in price, was met with widespread criticism almost as soon as it was proposed last November. The Trump administration had suggested the change would help lower drug prices by giving private Medicare plans more leverage over high-cost drugs. But patient advocates and drug makers said it would jeopardize patient care in life-threatening situations.

This post originally appeared in Inside Health Policy on May 16, 2019. 

Two consecutive administrations have failed to follow through with proposals to weaken Medicare Part D coverage protections in six drug classes. CMS again scrapped the idea in a final Part D rule it issued Thursday (May 16). When it proposed the rule last November, the agency had called for letting Part D plans exclude drugs in protected classes from formularies when their makers raise prices faster than inflation or when drug companies make new formulations of drugs already on the market. The proposed rule also called for allowing Part D plans to more broadly use step therapy and prior authorization for protected class drugs.