Op-ed: In Throes of Pandemic, Hoosiers in Assisted Living May Face This New Challenge

This post originally appeared in the Indianapolis Star on March 4, 2021

The COVID-19 pandemic has been extremely challenging for Indiana’s senior population. Having overseen our state’s assisted living and independent living facilities throughout the pandemic, we find the situation that thousands of senior Hoosiers are facing is heartbreaking and frightening.

Our senior care facilities do everything in their power to protect residents from COVID-19, and it's important that we continue to prioritize the health and safety of our most vulnerable population.
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In Washington, D.C., our elected officials must act to increase health care access for America’s elderly, ensuring they receive the medicine they need to thrive. Unfortunately, rather than protect our seniors, the Center for Medicare and Medicaid Innovation has chosen to further restrict access to high-quality care.

On Jan. 15, under the Trump administration, CMMI launched the Payment Modernization Model — a proposed set of new administrative rules governing Medicare Part D prescription drug plans.

These changes, CMMI claimed, would save Medicare money. But to achieve those cost savings, CMMI took aim at a vital aspect of Part D — a safeguard essential to Medicare recipients’ well-being — Medicare Part D’s six protected classes.

Under the current Medicare system, the six protected classes form a critical buffer against health complications. Essentially, the Part D program grants six separate types of medications — anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals and immunosuppressants — a special status within Part D health care plans.

The rule ensures that each formulary must cover “all or almost all” medications within each class. In this way, patients and their doctors aren’t required to conform to a “one-size-fits-all” treatment plan. They can tailor the medications to fit the needs of their particular condition, while resting assured that their Medicare Part D plan will cover the drugs that they need to stay healthy.

But under CMMI’s Payment Modernization Model, that would change.

CMMI’s new model would require that each Part D plan cover just one medication per protected drug class, effectively stripping formularies of treatment options.

And while this may, on the surface, appear to succeed at cutting costs for the government, it would do so at the expense of seniors’ health care access. Under the proposal, patients would undoubtedly find that their personalized treatment plans are no longer available in their Part D plans.

The drugs they rely upon to manage their health would cease to be covered. As a result, CMMI would force far too many seniors to utilize medications that don’t fully address their specific health care needs, resulting in less-effective, riskier treatments.

The utilization of less effective treatments may lead to a number of seniors requiring a higher level of care. This in turn would cost taxpayers additional expenses, offsetting any potential savings from restricting medications.

Such an outcome would have catastrophic consequences for patients, particularly seniors living in assisted living facilities. By weakening Medicare Part D’s six protected classes, the Payment Modernization Model practically guarantees that many of these individuals will experience health complications. Given that seniors are already at an elevated risk of COVID-19, compounding the threat further by reducing health care access is reckless and does not put patients first.

The Biden administration must reconsider this CMMI initiative, revoking the changes proposed under the Payment Modernization Model. Indiana’s seniors already have enough to worry about due to the pandemic; there’s no need to make the situation worse.

Dan Kenyon is executive director of the Indiana Assisted Living Association.