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Medicare Prescriptions Receive a Reprieve

Last update on: Feb 02 2017

A few weeks ago I reported on a proposal by the Center for Medicare and Medicaid to potentially limit some drugs covered by Part D. Briefly, Medicare has six classes of drugs that are protected under the program. If a doctor prescribes a drug in that class, it is considered covered. The agency proposed that three of those classes of drugs be removed from protected status. This would open the way for the agency to rule that only certain drugs would be covered, presumably opting for the lowest-cost drug among the alternatives.

There was a lot of backlash against the proposal, including from many usual allies of the administration. So, yesterday the agency quietly issued a letter stating the proposal is on the backburner for now. The proposal isn’t withdrawn. Instead, the agency says it won’t finalize the proposal any time soon and will take more time to discuss the issue with “stakeholders.”

The agency had endured a sustained torrent of criticism, including from a bipartisan group of 40 senators, members of key congressional committees, physicians in the House and more than 350 health care organizations. They were particularly concerned about narrower access to designated “protected classes” of drugs, meaning that seniors in Medicare Part D might have limited access to drugs like antidepressants or the immunosuppresants that transplant patients need.

Sometimes patients have to try several drugs before they find one that works for them,and the critics feared the policy change would be too restrictive and the appeals too burdensome.

Few came to the policy’s defense.

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