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Medicare to Rescind Part D Mental Health Drug Restrictions

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Medicare to Rescind Part D Mental Health Drug Restrictions

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The Centers for Medicare and Medicaid Services announced today that it will abandon its recent proposal to strip mental health and immunosuppressant drugs of their protected status in Medicare Part D.

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 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 to CMS. In addition, members of the National Council, the Partnership for Part D Access, and other concerned patient and provider groups submitted well over 1,000 comments to CMS opposing the changes.

The National Council applauded CMS for its decision not to finalize the proposed changes to the Six Protected Classes policy. “We are thrilled that CMS has listened to the loud chorus of support for maintaining beneficiary access to the life-saving drugs provided under Medicare Part D,” said Chuck Ingoglia, Senior Vice President of the National Council for Behavioral Health, which is spearheading the Partnership for Part D Access. “Although we need to remain vigilant on this issue, we commend today’s action by CMS will allow millions of seniors to continue to confidently rely upon Medicare to provide them the drugs they need.”

Since its inception in 2008, Medicare Part D has been effective at both improving health outcomes and lowering costs for patients. Despite the success of the program, in January, CMS published a proposed rule that would change the agency’s current policy requiring Medicare Part D plans to include on the  formularies “all or substantially all” of six protected classes of medication. The proposed changes would have removed antidepressants and immunosuppressants in 2015, and antipsychotics in future years, from the list of protected classes. The change would have enabled drug plans to remove these lifesaving medications from their formularies, jeopardizing care for millions of Americans.

In addition to preserving the Protected Classes policy, CMS also announced that it would not finalize the following portions of the proposed rule:

  • Reductions in the number of plans a Part D sponsor may offer;
  • Limitations on the use of preferred pharmacies; and
  • New interpretation of the non-interference provisions.

CMS noted it will gather additional input and reserves the right to advance changes in these areas in future years.