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.
This post originally appeared in POLITICO on May 17, 2019.
Assorted health care interests expressed relief Thursday following CMS' decision not to move forward with changes that would have let Medicare Part D and Medicare Advantage plans limit coverage of drugs in six categories known as “protected classes.” Some of the interests even expressed optimism policymakers won’t try to change the benefit again now that both Donald Trump and Barack Obama each failed to generate the needed political support for modification. Under the status quo, Part D plans must cover all drugs in the six protected classes: antidepressants, anti-psychotics, anticonvulsants, immunosupressants for transplant rejection, antiretrovirals and cancer drugs.
As designed by Congress, Medicare’s six protected classes policy guarantees access to treatments for Medicare patients with the most complex conditions, including cancer, HIV/AIDS, mental health conditions, epilepsy, organ transplants, and Parkinson’s
Washington D.C. — The Partnership for Part D Access, a broad-based coalition of health care stakeholders including over 20 diverse patient advocacy organizations, commended the Centers for Medicare and Medicaid Services (CMS) for not finalizing a proposal that would have substantially weakened Medicare’s six protected classes policy.
Partnership Applauds House Appropriations Committee for Report Expressing Concerns on ‘Six Protected Classes’
FOR IMMEDIATE RELEASE
May 7, 2019
Contact: Shea McCarthy
Washington D.C. — The Partnership for Part D Access, a broad-based coalition of health care stakeholders including over 20 diverse patient advocacy organizations, applauded the House Appropriations Committee for their report on the fiscal year (FY) 2020 Labor-HHS-Education spending measure, which raises concerns with a proposal from the Centers for Medicare and Medicaid Services (CMS) to weaken Medicare’s six protected classes policy.
This post originally appeared in Inside Sources on April 8, 2019.
When Congress passed Medicare Part D in 2003, it took steps to protect patients in the midst of a health crisis. When time is of the essence and the stakes are life-and-death, that is not when Washington bureaucrats or health insurers should be trying to eke out cost savings. But now unelected officials at the Centers for Medicare and Medicaid Services (CMS) are moving to strip those safeguards from law.
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 post originally appeared in the Memorial Examiner on March 28 2019.
Recently, the Centers for Medicare and Medicaid Services (CMS) proposed a troubling regulation that would weaken Medicare Part D, the federal program that helps 45 million American seniors and people with disabilities afford prescription drugs. Part D is unique among government programs. The federal government allows people to purchase coverage from private insurers. The government subsidizes these plans but otherwise lets Medicare beneficiaries choose the coverage that’s best for them.
This post originally appeared in Public News Service on March 29, 2019.
From coast to coast, people who rely on Medicare Part D could be left without their medications if a proposal by the Centers for Medicare and Medicaid Services is adopted. Medicare Part D is a federal program that subsidizes prescription drug costs for 45 million seniors and people with disabilities. The feds say they want to amend what's called the "six protected classes rule," and allow insurers to exclude many drugs from Part D plans. Fatima Hyacinthe, trainer and engagement director with the Black AIDS Institute, says people who rely on those medications already report discriminatory practices by insurance companies, despite the rules.
This post originally appeared on MySanAntonio.com on March 22, 2019.
One threat stems from the Trump administration, which has suggested weakening the so-called protected classes provision in Medicare “Part D.” Medicare’s Part D drug benefit has enabled seniors to purchase subsidized prescription coverage from private insurers. Part D regulations require every plan to cover all medications in six protected classes of therapies, including anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. This protection ensures that older adults who battle cancer, HIV/AIDS, depression, and other serious diseases have a full range of treatment options.