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.
Patient groups in our Partnership — representing individuals with cancer, mental illness, organ transplants, Epilepsy, Parkinson’s, and HIV — have questioned the growing narrative that the protected classes provide unrestricted access to these drugs. Looking to see if this was the case, we commissioned a study from Avelere to determine how the policy is actually being implemented. And the results are jarring.
Despite the statutory requirement that “all” drugs in the protected classes must be covered, Avalere’s analysis of Medicare Part D claims data found that on average, just 67 percent of available drugs from protected classes are being covered, and only 60 percent of brand drugs. Also, contrary to the notion that plans are limited in their ability to manage utilization, the data shows that plans consistently use prior authorization, step therapy, and tiering to encourage the use of lower-cost drugs. In fact, Avalere found that 39 percent of medications are subjected to some form of medication management, which in combination with other plan policies, resulted in 91 percent generic dispensing rate for drugs within the protected classes.
Medicare patients often have complex medical conditions and are known to react differently to medicines. That is why Congress enacted the protected classes policy, to ensure Medicare beneficiary access to the full range of available treatments. As Commissioner Buto pointed out when the Commission debated its policy, drugs in the protected classes are often “used in combination, and individual circumstances dictate which drugs are best.”
We believe the data compiled by Avalere calls into question the MedPAC recommendation to eliminate coverage for certain classes of medications within the protected classes as well as the Administration’s recent proposals to change the policy. On behalf of the patient community who relies upon the protected classes policy to access needed medications, we urge the Commission to consider this data and rescind its recommendation related to the protected classes.
Thank you for your time. I would be happy to share this recent data with the Commission in more detail, and appreciate your consideration of this important issue.
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