Inside Health Policy: Seniors Groups Warn Against Weakening Part D Beneficiary Protections

An article in Inside Health Policy reports that seven senior groups are lobbying both Congress and CMS to retain rules that make plans cover all drugs in Medicare’s six protected classes. The article — citing a report by the Alliance for Aging Research, Caregiver Action Network, Caregiver Voices United, HealthyWomen, National Association of Nutrition and Aging Services Programs, Partnership to Fight Chronic Disease, and RetireSafe — notes that the six protected classes policy has been a safety net for some of the most medically fragile and vulnerable Medicare beneficiaries. “These requirements safeguard beneficiary access to treatment options and offer protection against plan designs that could discriminate by discouraging enrollment of people relying on protected classes of medicines,” the report states. 

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The article in its entirety can be read below. 

Seniors Groups Warn Against Weakening Part D Beneficiary Protections
 
November 21, 2018
 
Seven seniors groups are lobbying Congress and CMS to keep in place rules that make plans cover all drugs in protected drug classes, to continue requiring that plans cover at least two drugs in all other classes and to reduce costs to beneficiaries by capping Medicare Part D spending and sharing rebates at the pharmacy counter. CMS is considering giving drug plans more leverage to negotiate lower prices for drugs in protected classes, which runs counter to the seniors groups recommendations, but the administration also wants to try out policies that are in line with the groups’ other suggestions.
 
“The six protected classes policy has been a safety net for some of the most medically fragile and vulnerable Medicare beneficiaries,” states the paper by Alliance for Aging Research, Caregiver Action Network, Caregiver Voices United, HealthyWomen, National Association of Nutrition and Aging Services Programs, Partnership to Fight Chronic Disease, and RetireSafe.
 
The groups wrote the report to help inform Congress and the administration as they consider changes to Part D. The administration published a blueprint for lowering drug costs early this year, and CMS is expected to publish soon a proposed rule that overhauls Part D. HHS officials have indicated they are considering getting rid of protections in the six drug classes. For example, CMS Administrator Seema Verma recently said the administration wants to give Part D plans the same negotiating power that commercial plans have, and she said the Trump CMS is “committed to ensuring that seniors are getting the best deal possible in all therapeutic classes, including the protected classes.”
 
The groups also are worried about losing the rule that Part D plans cover at least two drugs in each class. They say many people, especially people living with chronic conditions, need more than one drug in a class because it is often difficult to find regiments that work. That complexity increases when Medicare beneficiaries have multiple conditions due to the risk of drug interactions.
 
If Congress changes Part D, those changes should reduce seniors’ costs. Premiums have for a long time been the focus of policies aimed at controlling seniors’ costs, but costs are being shifted to beneficiaries in other ways, the seniors advocates say. From 2015 to 2018, the number of drugs subject to coinsurance increased nearly 20 percentage points.
 
“Too great an emphasis on lower premiums or other costs for all enrollees can go so far as to undermine the original purpose of insurance: namely, shielding those with high medical needs from the brunt of related expenses by spreading them over a larger group of people,” the report states.
 
Increasing coinsurance levels is all the more problematic because coinsurance and deductibles are based on list prices, which also are increasing, even though net prices are growing at a much slower rate. That’s why the groups also are urging Congress and the administration to share rebates at the point of sale.
 
An increasing number of seniors are reaching the catastrophic phase of coverage. Next year, catastrophic coverage starts once beneficiaries have spent $5,100 on drugs -- that number includes drug makers’ share of costs, which next year will be 70 percent of coverage gap spending. Drug companies had been responsible for 50 percent of coverage gap costs, and the new measure will speed seniors into catastrophic coverage even faster than in years past.
 
In 2015, 3.6 million Part D enrollees reached the catastrophic phase of drug coverage. One million of those beneficiaries did not receive low-income assistance, and that’s twice the number of enrollees who didn’t qualify for low-income assistance than reached catastrophic spending in 2007.
 
The groups say the rising number of beneficiaries who reach catastrophic coverage demonstrates the need for an out-of-pocket cap on Part D spending. Also, the groups say CMS could cap Medicare Advantage and drug plans administratively without changes to the law.