Last week we wrote about the unpopular proposed changes to Medicare Part D. Among the most problematic proposals was one to eliminate protected class status for several categories of medication under Part D. On Monday, in a letter to Congressman and Senators, the Centers for Medicare and Medicaid Services (CMS) announced that it had decided not to follow through on the proposed rule “at this time.” Healthcare stakeholders, including the Partnership for Part D Access, applauded CMS’ decision, but note that continued involvement is important for enrollees’ access to important prescription drugs.
Part D, also known as the Medicare prescription drug benefit, was enacted as part of the Medicare Modernization Act of 2003 and provides extensive drug coverage for seniors and the disabled, allowing them to get prescriptions as quickly as possible. Medicare Part D currently covers medicines for about 39 million beneficiaries. (Wall Street Journal). Medicare covers a long list of medications, but six drug classes have a “protected status,” including antidepressants, cancer drugs, and anti-seizure drugs. Medicare drug plans are required to pay for all “protected” medicines.
CMS’ proposed rule had proposed to end the protected status for antidepressants and immunosuppressant drugs or transplant drugs starting in 2015 and antipsychotic drugs potentially in 2016.
Last week we wrote that “the opposition to portions of the rule, or to the rule as a whole, appears to strongly outweigh any support.” In a February 5 letter to CMS, every member of the Senate Finance Committee expressed opposition to the proposed CMS changes to the protected classes policy. On March 3, a bipartisan group of 50 members of the House Energy & Commerce and Ways & Means committees sent a similar letter requesting that CMS reject the Administration’s suggested changes to the Part D program concerning the six protected classes policy and withdraw the proposal. Reuters mentioned that more than 370 organizations in total—representing insurers, drug makers, pharmacies, health providers, and patients—urged CMS to reconsider.
CMS took note of the response.
“Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time,” CMS Administrator Marilyn Tavenner advised in a letter sent Monday to members of the Senate and House of Representatives. “We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years.” The House is scheduled to vote on a bill March 11 by Rep. Renee Ellmers (R., N.C.) that directs Medicare to stop work on the proposed rule. (Reuters).
Also scrapped from the initial-700 page proposal was a plan to address “preferred pharmacy networks” and a limited two drug-plan options for seniors.
While CMS took heed of the enormous response to the proposed change to Part D, Marilyn Tavenner left open the door for Medicare changes in the future. We will keep you up to date on proposed rulemaking.