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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Republican Leaders to CMS: Do Not Revive Proposed Medicare Drug Restrictions

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In a letter last week, top Republicans on the House Energy and Commerce Committee called on the Centers for Medicare and Medicaid Services to refrain from revisiting a proposed regulation that would have made substantial changes to the Medicare Part D program. Among other changes, the proposed regulation would have stripped antidepressants and antipsychotics of their protected status in Part D, opening the door for plans to sharply limit their coverage of these medications. CMS announced early last month that it would not finalize this and other contentious aspects of the rule, but might revisit them at a later date.

Energy and Commerce Committee Chairman Fred Upton (R-MI) was joined by committee leaders Tim Murphy (R-PA), Joe Pitts (R-PA), Michael Burgess (R-TX), Joe Barton (R-TX), and Marsha Blackburn (R-TN) in penning the letter. The lawmakers called on CMS not to revive the proposed rule at any time in the future, noting that “we remain deeply concerned with your statement about pursuing some or all of these changes in the future and the harmful impact on seniors who depend on the Part D prescription drug benefit. Given [CMS’] failure to consider core concerns about the legal basis, policy rationale, and cost estimates cited when proposing these policy changes, it would be unacceptable for the Administration to move forward with these changes, including directly or indirectly codifying such changes as part of the 2015 call letter.”

The committee leaders also included a list of nine questions requesting further detail on the process by which the proposed rule was crafted, a breakdown of cost and legal analyses providing justification for the proposed rule, and more.

The National Council strongly supported the repeal of the proposed change to the protected classes policy and applauded CMS’ decision to refrain from finalizing that portion of the regulation. We remain concerned that the issue could be revisited in future rulemaking, and support efforts by stakeholders and Members of Congress to preserve the protected classes policy as it exists today.