This post originally appeared in Inside Health Policy on March 14, 2019.
A bipartisan group of more than 70 House lawmakers wants CMS to withdraw a proposal to weaken coverage protections in six classes of drugs, according to a March 13 letter to HHS Secretary Alex Azar. Patient and provider groups have been highly critical of the Trump administration’s proposal to let insurers use step therapy and prior authorization for drugs in those drug classes, and now CMS is feeling the pressure from Congress. The letter focuses on HIV drugs, which is the only class of drugs among the six that treats an infectious disease, but the lawmakers make clear they don’t want to weaken protections in any of the classes.
“We are concerned that prior authorization and step therapy requirements could have devastating public health outcomes for those receiving treatment of HIV and the additional 5 protected classes,” states the letter spearheaded by Reps. Barbara Lee (D-CA) and Will Hurd (R-TX).
Unlike in the past, today HIV patients are treated immediately upon diagnosis, and prior authorization would reverse gains that have been made in the treatment of the infection, the lawmakers say. Step therapy would let insurers make patients take older drug that have worse side effects than newer drugs. Some of those side effects, such as depression and suicidal risk, exacerbate the mental health challenges that many HIV patients face. Older drugs also are more complicated to take, and the resulting poorer medication adherence lets the virus grow resistant to drugs.
“Finally, we are concerned that these provisions of the proposed rule will have reverberating effects for patients suffering from multiple conditions that are currently covered and exacerbate health disparities among poor and minority communities,” the letter states.
The Obama administration also proposed weakening protected drug classes, though the Obama CMS called for eliminating protections in just three classes, and antiretrovirals were spared. The Obama administration withdrew that proposal after receiving strong pushback. -- John Wilkerson