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Michael Petruzzelli

, National Council for Behavioral Health

Medicare Commission Proposes Restrictions to Antidepressant Access

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Last week, the Medicare Payment Advisory Commission (MedPAC) released a draft recommendation that would remove two classes of drugs from the six protected classes under Medicare Part D. The proposed changes would restrict patients’ access to immunosuppressants and antidepressants, a move that could prevent Medicare beneficiaries from accessing the most appropriate, clinically indicated medication for their condition.

Congress has long supported protections for patients with conditions that require such therapies, including patients with severe and persistent mental illness, epilepsy and AIDS. In 2014, when the Centers for Medicare and Medicaid Services (CMS) proposed removing protected status for these classes of medications, it was forced to backtrack in the face of overwhelming opposition from patient and provider groups, along with the members of key committees in Congress.

“It is highly irresponsible for MedPAC to recommend this action, which doesn’t serve to save federal dollars or lives. In fact, plans already have the ability to manage drug benefits, and they already require fail first and prior authorization, even for protected classes,” said Chuck Ingoglia, Senior Vice President of Public Policy and Practice Improvement at the National Council. “The only thing this recommendation will do is make it harder for our most vulnerable citizens to get the treatment they need and for our providers to deliver that treatment to them.”

While no course of action has yet been finalized in the wake of MedPAC’s recommendation, the National Council and a coalition of national advocacy organizations – the Partnership for Part D Access – continue to actively work against proposals that would weaken patient protections under the six protected classes policy.