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Michael Petruzzelli

, National Council for Mental Wellbeing

MAPRx Coalition Submits Comments on 21st Century Cures Initiative

December 31, 2014 | Medicare | Comments
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Earlier this month, the Medicare Access for Patients Rx (MAPRx) Coalition, of which the National Council is a member, submitted comments on the Energy and Commerce Committee’s 21st Century Cures initiative. 21st Century Cures is a wide-ranging legislative initiative designed to foster comprehensive improvements and innovation in the U.S. health system. The MAPRx comments, submitted to Committee Chairman Fred Upton (R-MI) and Representative Diana DeGette (D-CO), proposed recommendations for improvement to the Medicare Part D Program.

The Medicare prescription drug benefit is a critical lifeline to millions of Medicare beneficiaries by providing access to prescription drugs. MAPRx’s recommendations are as follows.

  • Plans should be required to have a robust formulary and provide coverage for a variety of medications in each drug class or category.
  • Coverage should be required for Medicare Part D’s six protected classes of drugs and any additional classes where restricted access to those drugs would have significant health consequences.
  • Oversight of a prescription drug benefit should include monitoring of: plan operations; formulary design; plans’ use of utilization management tools; quality measures including customer services, access to needed drugs and overall satisfaction; and pharmacy and therapeutic committee membership.
  • Plans should be required to provide clarity and transparency on coverage and on consumer’s out-of-pocket costs.
  • Notice of non-coverage, appeals and exceptions process should be simple and understandable.
  • Rigorous oversight of medication utilization management tools (such as medication substitution, step therapy or quantity limits) is critical.

MAPRx is comprised of more than fifty-five national patient, beneficiary, caregiver, and health professional organizations devoted to helping people with chronic diseases and disabilities who rely upon prescription medications obtained through Part D. MAPRx member organizations advocate on behalf of these beneficiaries and collaborate with national and state policymakers to ensure they have the access to the medication therapies they need and deserve.

Read the full letter here.