02/04/2021
We wanted to alert you to recent changes planned for implementation under the Centers of Medicare and Medicaid Services (CMS) Part D Payment Modernization Model.
Medicare Part D, also called the Medicare prescription drug benefit, is a government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums. The Part D Payment Modernization Model is a voluntary program that tests new Part D payment structures to address rising costs in the Part D program. While new payment performance tests may be well intended, the new changes announced by CMS may undermine a vital component of Medicare's Part D program, the “six protected classes” policy.
Recognized as an essential patient safeguard in Part D since the inception of the program, the policy requires that plans cover all or substantially all medications within six classes, including antidepressants, and has long stood as a guarantee to Medicare beneficiaries reliant on these medications that their access to would never be in interrupted. However, without intervention, effective January 1, 2022, CMS plans to allow participating Part D plans to include on their formulary (i.e., the medications covered by that plan) only one drug per class. Such a change could have serious health consequences for this patient population.
Weakening the six protected classes policy will harm Medicare beneficiaries, an already vulnerable patient population, including seniors and patients with disabilities, that is more likely to be afflicted with multiple chronic conditions and whose complex conditions often require broad access to the medications that work for them, as prescribed by their healthcare provider. Not all patients respond to medication in the same way and allowing Part D plans to implement narrow formularies will be particularly detrimental. Patients with a brain health disorder often try several medications before finding a therapy that helps control their symptoms and has manageable side effects.
Protecting patient access to a full spectrum of the most clinically appropriate care is critical, particularly during the COVID-19 pandemic, when there is an urgent need for increased access to care. There is no “one size fits all” approach to this vulnerable patient population, and we are urging policymakers to maintain beneficiaries’ access to protected class drugs to ensure timely and quality care.
If you would also like to raise your voice to oppose these changes to Medicare Part D, you can do so by contacting your local Representative in Congress, or submit comments to this email address [email protected] by February 5th.
