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Archive: Six Protected Classes (Medicare Part D)

Capitol Connector
Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

Finalized Rule from CMS Preserves Medicare’s Six Protected Classes

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Shelley Starkey

The Centers for Medicare and Medicaid Services (CMS) released a final rule on Thursday aimed at addressing rising drug prices and out-of-pocket expenses under Medicare Part D and Medicare Advantage. Notably, the final rule did not include previously-proposed measures that would have provided exceptions to Medicare’s “six protected classes,” a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The announcement comes after six months of opposition to the proposals from Members of Congress and patient and provider advocates, including the National Council for Behavioral Health.

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Congressional Briefings Discuss Threats to Mental Health Medication Access

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Shelley Starkey

A recently proposed rule from the Centers for Medicare and Medicaid Services (CMS), if enacted, would threaten Medicare Part D participants’ access to critical prescription drugs including those often needed by individuals living with mental illness. The Partnership for Part D Access, of which the National Council for Behavioral Health is a founding member, hosted […]

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CMS Releases Medicare Part D and MA Drug Pricing Proposal

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Stephanie Pellitt

, National Council for Behavioral Health

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule on prescription drug pricing in Medicare Part D and Medicare Advantage (MA). Most notably, the proposal would provide new exceptions to Medicare’s “six protected classes” policy, a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The Partnership for Part D Access, a coalition headed by the National Council, immediately spoke out against these changes as harmful to patients’ health. Additionally, the proposal would permit Medicare Advantage plans to use step therapy for Part B drugs, provide physicians with real-time estimates of drug prices and alternatives and require the Part D Explanation of Benefits to include new drug pricing information.

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Trump Announces Blueprint to Lower Drug Prices

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Stephanie Pellitt

, National Council for Behavioral Health

Last Friday, President Trump announced the Administration’s plan to lower drug prices in a speech entitled ‘American Patients First,’ which highlights steps the Administration has taken, outlines future actions, and requests public comment on “even bolder actions” to bring down drug prices. The wide-ranging proposals include reforms to Medicare Part D and Part B, Medicaid, the Food and Drug Administration (FDA), the 340B Drug Discount program, and more.

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Independent Commission Recommends Changes to Medicare Part D

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Michael Petruzzelli

, National Council for Behavioral Health

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.

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Medicare Commission Proposes Restrictions to Antidepressant Access

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Michael Petruzzelli

, National Council for Behavioral Health

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.

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Medicare Advisers Discuss Potential Threat to Protected Classes Policy

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Michael Petruzzelli

, National Council for Behavioral Health

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.

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Congressman Tim Murphy Re-introduces Mental Health Reform Bill

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Representatives Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX) have reintroduced their bipartisan legislation enacting comprehensive reforms to the U.S. mental health delivery system. The Helping Families in Mental Health Crisis Act (H.R. 2646) was first introduced in 2013; the legislation is the culmination of an ongoing series of hearings Murphy has held as chair of the House Energy and Commerce Oversight and Investigations Committee in the wake of the tragic 2012 Newtown shooting.

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Bipartisan Legislation Introduced to Protect Medicare Enrollees’ Access to Mental Health Medications

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

New legislation in Congress would protect Medicare enrollees’ access to mental health medications by codifying an open access requirement that came under attack last year. The bipartisan Medicare Formulary Improvement Act (S. 648) is a response to a widely-condemned attempt by the Center for Medicare and Medicaid Services to limit patients’ access to these drugs – an effort that would have had a devastating effect on millions of Americans who rely on these therapies for their health and well-being.

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21st Century Cures Initiative Leaders Outline Goals for 2015

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Michael Petruzzelli

, National Council for Behavioral Health

New details emerged last week about a bipartisan House effort to draft a comprehensive health care bill known as 21st Century Cures. In an op-ed, House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Ranking Member Diana DeGette (D-CO) outlined five broad goals of the draft bill they plan to introduce later this month:

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Panelists Explain Importance of Mental Health Drug Access to Congress

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

The Partnership for Part D Access, of which the National Council is a member, this week hosted House and Senate congressional staff briefings to share patient and health care provider experiences that demonstrate the importance of protecting beneficiary access to proper care under Medicare’s Six Protected Classes policy.

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CMS Finalizes Part D Rule; Leaves Opening for Future Action on Protected Classes

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

The Centers for Medicare and Medicaid Services (CMS) last week issued its final rule on Medicare Part D changes for fiscal year 2015. While codifying a range of fraud and abuse-related proposals, the rule – as signaled in an earlier letter to Congress – does not adopt controversial proposed modifications that would have stripped mental health drugs of their protected status in Part D.

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Several House Committee Members Introduce Broad Behavioral Health Bill

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Earlier this week, members of the House Committee on Energy and Commerce – which oversees many policies related to mental health and substance use – introduced legislation to improve the U.S. behavioral healthcare system.

The Strengthening Mental Health in Our Communities Act (H.R. 4574) was introduced by Ron Barber (D-AZ), Diana DeGette (D-CO), Doris Matsui (D-CA), Grace Napolitano (D-CA), and Paul Tonko (D-NY).

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

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

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.

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Medicare to Rescind Part D Mental Health Drug Restrictions

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

The Centers for Medicare and Medicaid Services announced today that it will abandon its recent proposal to strip mental health and immunosuppressant drugs of their protected status in Medicare Part D.

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Dozens of Lawmakers Call on CMS to Rescind Drug Restrictions

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

A bipartisan group of 50 lawmakers this week called on the Centers for Medicare and Medicaid Services (CMS) to preserve patients’ access to important mental health and immunosuppressant medications in Medicare Part D.

The letter, written by members of the House Ways & Means and Energy & Commerce Committees, noted that the six protected classes policy is “a critically important component of what has made Part D successful over the past eight years.”

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Speak Up for Mental Health Drug Access: Submit Your Comments Today!

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Do you support preserving patients’ access to needed mental health drugs in Medicare Part D? If so, we have good news: the regulations are still in draft form – meaning that we can push CMS to reverse course, if enough citizens make their concerns known!

There are three simple things YOU can do today:

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National Groups Launch Partnership to Fight Proposed Medicare Drug Restrictions

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

A broad-based alliance of patient groups and health care stakeholders yesterday announced the formation of the Partnership for Part D Access, a coalition committed to protecting access to necessary medications for patients in the Medicare Part D prescription drug program. The Partnership for Part D Access opposes a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would weaken the successful “protected classes” policy in Medicare Part D by restricting access to antidepressants, antipsychotics and immunosuppressants for vulnerable patients.

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National Council to Host Stakeholder Call on Medicare Part D Drug Access

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

On Friday, February 21st at 3:00 p.m. eastern, the National Council will host a national open-to-the-public policy call for attendees to learn more about a recent proposal that will make it harder for Medicare beneficiaries to access certain Part D drugs.

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Senate Committee Urges CMS to Preserve Mental Health Drug Access

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

In a rare display of unanimity, the 24 members of the Senate Finance Committee have sent a joint letter to the Centers for Medicare and Medicaid Services urging the agency to roll back a proposal that would drastically limit consumers’ access to mental health drugs.

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