Medicare Part D plans are generally required to provide coverage for at least two drugs in each therapeutic class. But the Centers for Medicare and Medicaid recognized that this may be insufficient for certain drug categories, including many of those used to treat mental health conditions, epilepsy, Parkinson’s disease, lupus, HIV/AIDS, cancer and organ transplants. For six protected classes of drugs, Medicare requires plans to cover most of the drugs in the category.
In President Donald Trump’s final days in office, however, his administration announced a proposal that would give participating plans more flexibility in limiting coverage for drugs in the protected categories. The patient advocacy groups are calling on the Biden administration to reverse this policy proposal.
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