This post originally appeared in STAT News on May 16, 2019 

WASHINGTON — The Trump administration is backing off a controversial proposal to chip away at existing safeguards that require Medicare to cover all drugs for conditions like depression and AIDS. The initial proposal, which would have allowed private Medicare plans to refuse to pay for certain drugs for chronic conditions that spiked in price, was met with widespread criticism almost as soon as it was proposed last November. The Trump administration had suggested the change would help lower drug prices by giving private Medicare plans more leverage over high-cost drugs. But patient advocates and drug makers said it would jeopardize patient care in life-threatening situations.

This post originally appeared in Inside Health Policy on May 16, 2019. 

Two consecutive administrations have failed to follow through with proposals to weaken Medicare Part D coverage protections in six drug classes. CMS again scrapped the idea in a final Part D rule it issued Thursday (May 16). When it proposed the rule last November, the agency had called for letting Part D plans exclude drugs in protected classes from formularies when their makers raise prices faster than inflation or when drug companies make new formulations of drugs already on the market. The proposed rule also called for allowing Part D plans to more broadly use step therapy and prior authorization for protected class drugs.

This post originally appeared in POLITICO on May 17, 2019. 

Assorted health care interests expressed relief Thursday following CMS' decision not to move forward with changes that would have let Medicare Part D and Medicare Advantage plans limit coverage of drugs in six categories known as “protected classes.” Some of the interests even expressed optimism policymakers won’t try to change the benefit again now that both Donald Trump and Barack Obama each failed to generate the needed political support for modification. Under the status quo, Part D plans must cover all drugs in the six protected classes: antidepressants, anti-psychotics, anticonvulsants, immunosupressants for transplant rejection, antiretrovirals and cancer drugs.

​Washington D.C. — The Partnership for Part D Access, a broad-based coalition of health care stakeholders including over 20 diverse patient advocacy organizations, commended the Centers for Medicare and Medicaid Services (CMS) for not finalizing a proposal that would have substantially weakened Medicare’s six protected classes policy. 

The Centers for Medicare and Medicaid Services (CMS) issued a final rule that makes no changes to the current six protected classes policy — completely eliminating the potentially damaging changes included in a proposed rule released several months earlier. Instead, the agency finalized current practices that allow for prior authorization (PA) and step therapy (ST) to only be used within the protected classes for new starts.  Also consistent with current practice, antiretrovirals remain excluded from utilization management altogether. Importantly, CMS did not finalize exceptions for new formulations of existing drugs or drugs whose prices increase above the urban consumer price index (CPI-U). 

“Medicare beneficiaries with the most complex, chronic conditions are breathing a sigh of relief,” Chuck Ingoglia, the Executive Director of the Partnership said in a statement. “This rule cements the protected classes policy as an essential patient safeguard in Medicare’s prescription drug program."

​The Centers for Medicare and Medicaid Services (CMS) issued a final rule that makes no changes to the current six protected classes policy — completely eliminating the potentially damaging changes included in a proposed rule released several months earlier. Instead, the agency finalized current practices that allow for prior authorization (PA) and step therapy (ST) to only be used within the protected classes for new starts.  Also consistent with current practice, antiretrovirals remain excluded from utilization management altogether. Importantly, CMS did not finalize exceptions for new formulations of existing drugs or drugs whose prices increase above the urban consumer price index (CPI-U). 

“Medicare beneficiaries with the most complex, chronic conditions are breathing a sigh of relief,” Chuck Ingoglia, the Executive Director of the Partnership said in a statement. “This rule cements the protected classes policy as an essential patient safeguard in Medicare’s prescription drug program."

Washington D.C. — The Partnership for Part D Access, a broad-based coalition of health care stakeholders including over 20 diverse patient advocacy organizations, applauded the House Appropriations Committee for their report on the fiscal year (FY) 2020 Labor-HHS-Education spending measure, which raises concerns with a proposal from the Centers for Medicare and Medicaid Services (CMS) to weaken Medicare’s six protected classes policy.