Two leading Medicare beneficiary advocacy groups have joined the chorus of stakeholders calling upon the President Joe Biden to take immediate action to rescind the Trump administration’s last-minute attempt to weaken coverage requirements for drugs within the six protected classes policy.
Led by the Medicare Rights Center and the Center for Medicare Advocacy, the letter calls on the administration to rescind formulary flexibilities for plans that participate in the Part D Payment Modernization Model. These changes would allow plan to cover only one drug per therapeutic class, and would drop the requirement for coverage of “all or substantially all” of the drugs in five out of the six protected classes.
In their letter, the organizations cite a June 2020 analysis by Avalere demonstrating that Medicare prescription drug plans are consistently applying utilization management tools to manage spending on prescription drugs within Part D. This analysis is consistent with the Partnership-commissioned Avalere study from 2018 that clearly demonstrates that Medicare’s existing protected classes policy is working as intended for beneficiaries with cancer, HIV, transplant recipients, epilepsy, and mental illness, among others.
“We encourage CMS to rescind the formulary flexibilities it recently extended to plans that participate in the Part D Payment Modernization Model,” the letter states. “As analysis of earlier proposals that relax restrictions requiring plans to cover substantially all medications in the six protected classes shows, these flexibilities are unlikely to significantly drive down costs and may greatly restrict access, above and beyond the impact of utilization management tools.”
The letter in its entirety can be read here.
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