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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Dozens of Lawmakers Call on CMS to Rescind Drug Restrictions

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A bipartisan group of 50 lawmakers this week called on the Centers for Medicare and Medicaid Services (CMS) to preserve patients’ access to important mental health and immunosuppressant medications in Medicare Part D.

The letter, written by members of the House Ways & Means and Energy & Commerce Committees, noted that the six protected classes policy is “a critically important component of what has made Part D successful over the past eight years.” Six protected classes refers to the policy that requires Part D plans to cover all or substantially all medications within certain classes: antipsychotics, antidepressants, immunosuppressants, antineoplastics, antiretrovirals, and anticonvulsants. A new proposed rule from CMS would strip mental health and immunosuppressant drugs of their protected status, allowing plans to limit the number of medications they cover for consumers living with mental health conditions or transplants.

In their letter, the Members of Congress urged CMS “to maintain this important policy and not finalize this proposed rule” due to the concern that “this proposed policy will place harmful limits on Medicare beneficiaries’ access to necessary medications that would otherwise be covered by protected status.”

The Partnership for Part D Access, a broad-based coalition of health care stakeholders committed to protecting patient access to necessary medications in the Medicare Part D prescription drug program, the letter. “The proposed CMS rule will decrease access to medication and jeopardize patient health, especially for those beneficiaries living with mental illness. We applaud these members of the House of Representatives for taking this vitally important stand and for helping to protect vulnerable patient populations,” said Chuck Ingoglia, Senior Vice President of the National Council, which is spearheading the recently formed Partnership for Part D Access.

“Medicare Part D, including the Six Protected Classes, is working,” said Carl Schmid, Deputy Executive Director of The AIDS Institute. “Beneficiaries, including those with HIV, are able to access the medications that their doctors prescribe. We don’t understand why the Obama Administration would propose to diminish that access.”

“The Epilepsy Foundation is extremely troubled by the proposed changes from CMS to the protected classes. Weakening patient protections for some of the most medically fragile Medicare beneficiaries at a time when we should be strengthening access is not only disappointing but dangerous. We strongly urge CMS to not only rescind these changes but consider strengthening the class through policies that ensure there are no unnecessary administrative barriers,” said Angela Ostrom, Vice President, Public Policy and Advocacy, Epilepsy Foundation.

The letter reflects the growing bipartisan Capitol Hill consensus opposing changes to the six protected class policy. In a February 5 letter to CMS, every member of the Senate Finance Committee expressed concern over the proposed CMS changes to the protected classes and strongly urged CMS to continue providing access to these drug classes exactly as it does today.