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"Bloomberg BNA: Protecting Medicare’s Protected Classes: Chapter Two"

July 14, 2016

Bloomberg BNA: Protecting Medicare’s Protected Classes: Chapter Two

Mindy Yochelson of Bloomberg BNA’s Health Care Division reflects when Medicare first proposed to remove three of six categories from the Part D drug benefit’s protected classes in 2014. She compares the events to sentiments felt today by patients and advocacy groups after Congress’ Medicare advisors, the Medicare Payment Advisory Commission (MedPAC), recommended removing two protected classes from the policy earlier this year. The reporter highlights two Senators – Chuck Grassley (R-IA) and Sherrod Brown (D-OH) – who have since proposed new legislation that goes against MedPAC’s recommendation and instead requires Medicare Part D sponsors to include all covered drugs in the six categories on their formularies.

PROTECTING MEDICARE’S PROTECTED CLASSES: CHAPTER TWO

Remember the fireworks that exploded in 2014 when Medicare proposed to remove three of six categories from the Part D drug benefit’s protected classes?  

I do.  

Things cooled down after the final rule came out with the protected classes provision gone.  But a reignite was threatened last month when Congress’ Medicare advisers recommended permitting drug plans to remove two of the classes--antidepressants and immunosupressants for transplant rejection--from protected classes requirements.  

After the 2014 rule was proposed, a worried woman from Seattle named Diane was one of a few who wrote to me after seeing stories on the web. She asked to be kept abreast of the rulemaking. As someone with a bipolar disorder, she depended on antipsychotics, one of the categories that Medicare was considering excluding.  

And I’m just a reporter. The Medicare agency received over 7,600 comments on the 2014 rule that proposed a  variety of changes on the drug benefit and the Medicare managed care program. A  good chunk, however, dealt with the protected classes or “classes of clinical concern.”  

The policy requires Medicare drug plans to include substantially all drugs in six classes on their formularies. A goal is to ensure that beneficiaries have access to a wide variety of treatment options for certain conditions.

In a June report, though, the Medicare Payment Advisory Commission (MedPAC) said it believes that maintaining these classes can result in financial disadvantages for Part D due to increased drug prices and overutilization. The classes it recommended for removal have a number of generic versions of drugs available, the commission said.

Although MedPAC’s recommendations are just that—recommendations--a bipartisan duo in Congress’ upper chamber wants to make sure they aren’t acted upon.  

Sens. Charles Grassley (R-Iowa) and Sherrod Brown (D-Ohio) are sponsors of legislation that would require Part D sponsors to include all covered drugs in the six categories on their formularies. After MedPAC’s report came out, they wrote to the Medicare agency reminding them that “Congress remains steadfast in its commitment to maintaining this important protection.”

What happens next is anyone’s guess. But a good bet is that nothing will occur in this explosive area until after the presidential election.


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