At a recent hearing of the Energy and Commerce Committee featuring HHS Secretary Alex Azar, at least four key members of the committee raised concerns with the administration's proposal to weaken Medicare's protected classes policy — including Ranking Member Greg Walden (R-OR) and Health Subcommittee Chair Anna Eshoo (D-CA). For example, when talking about the proposal that could require patients who are stabilized on an existing treatment to go through step therapy or prior authorization, Ranking Member Walden emphasized that "no patient wants to go through that, and it’s something we’ve got to pay attention to." Later, Health Subcommittee Chair Eshoo added that "I think both sides hold the same view so we have to move forward and correct that situation.”
Transcripts and Video of Key Exchanges
RANKING MEMBER WALDEN: “CMS has proposed a rule to change the formularies for patients in Part D protected classes. What assurances can you provide my constituents and those patients they’ll still be able to get access to the medications they need?”
SECRETARY AZAR: “Thank you for that question, because there is a lot of misunderstanding there. Of course, with the protected classes, what’s happening we, as a government, have disabled these middlemen — the pharmacy benefit managers — from being able to negotiate against the drug companies to get discounts. So the very drugs in the commercial space may be yielding 30 percent average discounts, we’re getting zero to six percent. So what we’re proposing — and it’s a proposal, we’re getting very important feedback from disease groups in and we’ll look at it — is to allow some of the basic formulary management tools used in the commercial space for regular, commercial employees. For instance step therapy, try this drug before that drug. Prior authorization — make sure this drug is being used for the right indication. Without speedy appeals and exceptions processes and with the choice that’s embedded into Part D where you can pick a plan, if it’s not meeting your needs, you can choose a different one. But we’re hearing the feedback and we’ve heard very vigorous feedback. We want to protect our beneficiaries, of course.”
WALDEN: “Because I have heard from some patients today — before this becomes a rule — that they have a drug that works, they change plans, something happens, and they’re told they’ve got to go back through all these drugs they know don’t work to get to the one that does. And no patient wants to go through that, and it’s something we’ve got to pay attention to.
AZAR: “I’ve heard that feedback and obviously we’ll take that very seriously.
REP. DORIS MATSUI (D-CA): “Let me just say this. I want to reiterate the concerns of Ranking Member Walden regarding the protected classes. I’ve gotten many of my constituents stepping forward that they are really very concerned regarding the step therapy. They have medication that they already know works, and to think that they have to go back again and go through the steps, that would really bring them back to a place they don’t want to be.”
ESHOO: “I thank the gentlewoman. I think the issue that Ms. Matsui and Mr. Walden brought up... I think both sides hold the same view so we have to move forward and correct that situation.”
REP. RICHARD HUDSON (R-NC): “The president’s pledge in his State of the Union Address to eliminate new HIV infections by 2030 is a far reaching and important goal for U.S. public health. The financial resources proposed in yesterday’s budget released speaks to the president’s commitment to improving diagnosis testing and linkage to care for HIV. I commend the President for taking such a monumental effort and hope to do what I can to support his plan. Given his goal though, I must ask about a problem a number of my constituents that are HIV patients have raised to me. Medicare Part D provides for protected classes where Medicare must generally cover all drugs within that class with HIV drugs being one of the current six classes… My basic question is how does HHS intend on balancing the goal of introducing cost control measures such as prior authorization and step therapy with new eliminations of new HIV infections by maintaining patient adherence to working HIV regimens in the HIV space?”
AZAR: “Happy to get back to you on that in writing if that’s okay?”
HUDSON: “It’s an important issue, so I appreciate your response.”
ESHOO: “I was expecting a long answer from the Secretary, so we hope that he’ll be able to get back to you.”
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