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Independent Commission Recommends Changes to Medicare Part D

Capitol Connector
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Michael Petruzzelli

, National Council for Behavioral Health

Independent Commission Recommends Changes to Medicare Part D

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An independent payment advisory panel this week finalized a package of recommendations to Congress that would implement a number of harmful changes to the Medicare Part D program. The panel, the Medicare Payment Advisory Commission (MedPAC), recommended that Congress remove antidepressant and immunosuppressant drugs from the protected classes, change low-income beneficiary cost-sharing, and implement other reforms. These recommendations, if enacted, would greatly limit access to needed medications for patients across the country.

The Medicare Payment Advisory Commission is an independent advisory body to Congress on all matters related to Medicare. To be clear, their recommendations do not carry the weight of law, nor do recommendations demand a response or action from Congress.

The finalized MedPAC recommendations urge Congress to do the following:

  • Modify the Part D “six protected classes” policy. MedPAC recommended the removal of antidepressants and immunosuppressants from the protected status that ensures their greater availability. Such a chance would no longer require formularies to provide “all or substantially all” of the drugs in these classes, greatly limiting patients’ access to medications. Also recommended was a streamlined process for formulary changes; requirements for prescribers to provide supporting statements with more clinical rigor when applying for exceptions; and the use of new tools when managing specialty drug benefits.
  • Modify the Part D low-income subsidy policy. MedPAC recommended changes to copayments for low-income Medicare beneficiaries to encourage use of generic drugs when available in selected drugs classes. It was also recommended that cost-sharing for generic medications be reduced or, in some cases, altogether eliminated. Such changes would make it more difficult for patients to access brand name drugs, which could harm patients who need access to a newer medication.

Since its inception in 2003, the Medicare Part D program has enjoyed strong bipartisan support in Congress. Advocates from across the country have been fighting to protect Medicare Part D for more than two years. In 2014, the Centers for Medicare and Medicaid Services proposed similar changes to the program, modifying protected status for specific classes of drugs. This proposed action was met with swift and concrete action by advocates, led by the National Council, and was ultimately withdrawn.

Just last week, former Senator Gordon Smith (D-OR) penned an op-ed urging MedPAC to maintain current Part D policies. “MedPAC’s proposal to eliminate antidepressants and immunosuppressants would have a particularly stark effect on the treatment of patients who suffer from both physical and mental illnesses,” he wrote. “The co-morbidities of certain diseases – such as depression and cancer – demand a well-tailored, stable treatment plan that takes into account the complicated interactions of disease and medicine. Changing the equation by forcing patients onto a new drug regimen could have a disastrous effect on a patient’s likelihood to adhere to their treatment and possibly on their overall health.”

While there seems to be no indication of upcoming congressional activity on this issue, the National Council and the Partnership for Part D Access stand ready to preserve Medicare Part D. Stay tuned to Capitol Connector to keep informed about future efforts to modify Medicare beneficiaries’ access to these important drugs.

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