"Partnership for Part D Access Applauds CMS’ Decision to Withdraw “Protected Classes” Proposal"

March 10, 2014

Partnership for Part D Access Applauds CMS’ Decision to Withdraw “Protected Classes” Proposal

People fighting to combat mental illness, epilepsy, HIV/AIDS, organ failure, and cancer were on the winning side of those battles today.  This afternoon, the Centers for Medicare and Medicaid Services (CMS) announced a decision to drop a proposal that would significantly limit the ability of many Medicare beneficiaries to get the prescription drugs that help them manage disease and illness. 

In a letter to members of Congress, CMS Administrator Marilyn Tavenner said that the agency will not finalize the proposed rule to eliminate protected class status for several categories of drugs under Medicare Part D “at this time.”  Portions of a January 2014 proposal to restructure Medicare Part D and Medicare Advantage would have excluded antidepressants and immunosuppressants for the 2015 coverage year (and antipsychotics in 2016) from their status as protected drug classes within the nation’s popular prescription drug program.  The Partnership for Part D Access has applauded CMS on their decision to withdraw this dangerous proposal.

Unlike the many partisan healthcare issues that have rankled Congress of late, bipartisan lawmakers and a diverse group of stakeholders have been united in their support of the protected classes policy.  Indeed, CMS’ decision comes on the heels of a February 5 letter to CMS in which every member of the Senate Finance Committee expressed opposition to the proposed changes to protected classes. And on March 3, a bipartisan group of fifty members of the House Energy & Commerce and Ways & Means Committees sent a similar letter to CMS requesting that the agency withdraw the suggested changes.

Near unanimous support for the six protected classes policy reflects a broad agreement that vulnerable patient populations should have access to a full range of therapies under Medicare Part D. Medicare beneficiaries are significantly more likely to have multiple chronic conditions or significant disabilities than the general population. Given the complex health needs of Medicare enrollees, it is essential that policies impacting access to prescription medications account for their unique health characteristics.  No two patients are alike, and no one drug is guaranteed to work for all of them. 

CMS’ decision astutely acknowledges the bipartisan understanding that a healthier population benefits both patients and taxpayers. When beneficiaries do not have access to needed medication, patients and taxpayers incur additional costs in the form of avoidable hospitalizations, physician visits and other medical interventions that are otherwise preventable with proper adherence to medication.  The guarantee of access to the most appropriate medications will continue to defray costs in Medicare and Medicaid by limiting admittance to in-patient care and emergency departments due to the destabilization of patients’ conditions.

The Partnership for Part D Access would like to thank the thousands of stakeholders who engaged in the regulatory process by submitting comments to CMS and the Department of Health and Human Services (HHS).  In fact, over 1,000 comments were submitted from individuals through our website 

Nevertheless, our work is not complete, and the Partnership will continue to work with CMS, Capitol Hill and the broad community of advocates to ensure that patients maintain this access to life-saving drugs under Medicare Part D in the future.  In her letter to Congress, Administrator Tavenner notes that CMS may look to advance these proposed changes “in future years.”  We need to remain vigilant on this issue, and will continue to ensure that CMS allows millions of seniors to rely upon Medicare to provide them access to the drugs they need.

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