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Michael Petruzzelli

, National Council for Mental Wellbeing

Medicare Advisers Discuss Potential Threat to Protected Classes Policy

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In 2014, the Centers for Medicare and Medicaid Services (CMS) attempted to eliminate protected status for antidepressants and antipsychotics in Medicare Part D prescription drug plans. After strong bipartisan opposition from both legislators and advocates alike, CMS abandoned its proposal but left the door open for future action. Last week, the Medicare Payment Advisory Commission (MedPAC) took an important step toward that action when it considered proposed policy options for Medicare, including the possibility of eliminating protected status for two of the protected drug classes, without specifying which classes would be affected.

The Medicare Protected Classes Policy requires Part D plans to include on formularies “all or substantially all” of six protected classes of medication. These medications include: antidepressants, antipsychotics, anticonvulsants, antineoplastics, antiretrovirals and immunosuppressants. This policy has been in effect since the inception of Part D and has enjoyed strong bipartisan support in Congress. The Affordable Care Act strengthened this policy by codifying it in federal statute, while granting CMS the authority to specify what criteria it would use to identify protected classes.

While no course of action has yet been finalized, the National Council and its coalition of national advocacy organizations – the Partnership for Part D Access – continue to actively monitor CMS and congressional action on protected classes. The Commission plans to revisit Part D plans during its March public meeting, followed by official recommendations to Medicare in April.