January 21, 2019
By Kenneth E. Thorpe
The Trump administration is poised to undermine seniors’ access to lifesaving medications.
It recently proposed a rule that would weaken patient protections within Medicare’s “Part D” prescription drug benefit. By law, Part D drug plans are required to cover all drugs in six “protected classes” of medicines. This requirement ensures that seniors and people with disabilities have widespread access to drugs used to treat cancer, depression, HIV and more.
The administration wants to allow insurers to stop covering some drugs in the six protected classes. This change, if implemented, could result in poorer health care outcomes for Medicare’s most vulnerable beneficiaries – and inflate health spending in the long run.
Medicare Part D is unique among government programs. Instead of providing health benefits directly, the government outsources that responsibility to private insurers. These insurers compete against one another to sell drug plans to beneficiaries. The government subsidizes and regulates coverage, but otherwise adopts a mostly hands-off approach to the program.
This model has been overwhelmingly successful. Today, more than 44 million Americans – or roughly three in four Medicare beneficiaries – utilize the program. Eight in 10 seniors are satisfied with their plans. Generous patient protections, especially the “protected classes” clause, play a big role in this high satisfaction rating.
Right now, Part D plans are required to cover “all or substantially all” anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. These medications treat various chronic conditions, including cancer, HIV and epilepsy. This ensures that doctors can prescribe whatever medication they feel is best for each patient.
The administration’s proposed rule doesn’t afford patients or their doctors this flexibility. Part D plan sponsors would no longer be required to cover all drugs in the six classes. The change would take effect in 2020.
The administration says the reform would give insurers more leverage to negotiate steeper drug discounts from manufacturers. Thus, patients and taxpayers would benefit in the form of lower plan premiums.
Patient advocacy groups aren’t buying it. In fact, nine organizations – including the Alliance for Aging Research, HealthyWomen and the National Association of Nutrition and Aging Services Programs – warned against the change.
Building barriers to treatment harms both patients and taxpayers. This latest proposal is a shortsighted approach to Medicare reform.
Kenneth E. Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease.