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Part D Six Protected Classes
In 2003, Congress created the Medicare Part D prescription program. When the program was implemented, CMS required Part D plans to include on their formularies “all or substantially all” drugs within six classes: antidepressants, antipsychotics, anticonvulsants, antineoplastics, antiretrovrials and immunosuppressants. This policy has been instrumental in ensuring Medicare beneficiaries with complex or severe mental health needs can access clinically appropriate treatment without undue burdens.
In January of 2014, CMS announced a proposed rule that would eliminate protected status for antidepressants, antipsychotics and immunosuppressants. After a vocal outpouring of opposition from consumer and provider groups, spearheaded by the Partnership for Part D Access, of which the National Council is a member, CMS announced it would not finalize its proposed changes to the protected classes. However, CMS left the door open for future rulemaking, leaving advocates concerned the agency may revisit this harmful proposed change.
In January of 2021, CMS once again announced a harmful new proposal that would undermine key patient protections in Medicare’s prescription drug program, allowing Medicare Part D plans to deny patients access medications used to manage complex conditions such as cancer, mental illness, HIV-AIDS, epilepsy, Parkinson’s, and organ transplantation. The proposed regulation was a step against some of the most vulnerable people in our communities and the bipartisan lawmakers who have tirelessly defended the merits of Medicare’s protected classes policy.
The National Council and the Partnership for Part D Access are continuing to advocate for maintaining beneficiary access to the full range of available medications under Medicare Part D. Together, we will work with the Biden administration and Congress to reverse CMS’ policy, and ensure we give people in our nation with the most complex conditions — including cancer, mental illness, HIV-AIDS, epilepsy, Parkinson’s, and organ transplantation — access to the medication they need to best achieve the next step of a treatment plan… but more importantly, giving them hope for the future.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes sweeping reforms to payments under Medicare Part B. Click here to learn more, access resources and most importantly get guidance on how to prepare for the reforms.
In The News
The National Council continues to advocate for increased access to mental health and addiction services through Medicare. For recent news about Medicare, visit Capitol Connector.