Lawmakers on Mental Health, HIV Caucuses Urge Biden to Rescind Trump Changes to Part D Demo

Members of the Congressional Mental Health and HIV Caucuses recently urged the Biden administration to revoke a final-hour request by the last administration to weaken Medicare protected class drug coverage. The lawmakers implored the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) to reconsider the changes to the Medicare Part D Payment Modernization (PDM) model, noting the new model doesn’t fairly take into account the public health implications for patients that utilize drugs under the six protected classes.  ​

The letter advocates for the Acting HHS Secretary and Acting CMS Administrator to pull back new allowances under the PDM model that would allow participating plans to weaken coverage requirements to one drug per class, as well as limit coverage of medication in all six protected classes by CY 2023. The lawmakers note that Pat D plans are already equipped with the necessary tools to manage spending and encourage the use of generics when possible for the six protected classes.
 
“These proposed changes fail to consider the unique needs of patients who need the treatment that is best for their condition, or patients who must try different treatments before finding the right treatment for their needs,” the letter explains. “we do not believe these formulary flexibility changes to the model would result in significant cost savings but will instead push access to essential medications out of reach for vulnerable patients.”
 
The bipartisan group of 67 members joined “significant opposition from Congress, patient groups, providers, and other stakeholders” to the potential changes to protections for the six protected classes.
 
The letter in its entirety can be read here.