The Trump administration recently proposed a major change to Medicare’s prescription drug benefit. The misguided reform could deprive seniors of life-saving medicines.
The administration wants to allow the insurers who administer Medicare drug plans to stop covering certain medicines and impose restrictions on the medications they do cover. The changes, contained in a proposed rule released by the Centers for Medicare and Medicaid Services, would affect medicines in six “protected classes” — anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants.
These drugs help patients beat back HIV, cancer, arthritis, and more.
Medicare’s drug benefit, known as “Part D,” works wonders for American seniors. Since Part D was established in 2006, roughly 200,000 enrollees have lived at least one year longer thanks to the program.
The protected classes are a big part of this success. Federal law requires Part D plans to cover all medicines in those six classes. This requirement ensures doctors can prescribe whichever drugs are best suited to each patient.
CMS has threatened to weaken these protections. Under its’ new guidance, patients could be pigeonholed into specific therapies regardless of their doctor’s opinion.
For starters, insurers would be permitted to employ “step therapy” requirements for drugs within the protected classes. In this scheme, a patient must first try — and fail on — the cheapest available therapy before their insurer will subsidize higher-tier treatments.
Take depression. A popular antidepressant could curb depression and anxiety symptoms for the majority of beneficiaries. For a few patients, however, that same drug could aggravate symptoms, inducing side effects like blurred vision and even suicide.
Seniors, particularly those battling serious diseases, don’t have time to waste on ineffective treatments. For some cancer patients, finding the right treatment from the start is literally a matter of life and death.
Another facet of CMS’ plan permits insurers to forgo covering protected drugs should their cost increase faster than the general rate of inflation.
Profit-hungry insurers could stop covering crucial medications to save a buck.
Faced with fewer — if any — drug options, patients could be forced to pay out of pocket for recommended therapies. Others might resort to less effective, cheaper drugs that their insurance will cover.
Some could stop taking medicines entirely. This practice, known as medication non-adherence, is already responsible for 125,000 deaths and 10 percent of hospitalizations annually.
These examples underscore the need for doctors to prescribe whichever drugs make the most sense for their patients. This is why the protected classes were created in the first place.
It’s no surprise that patient advocacy groups oppose these changes. The American Cancer Society’s Cancer Action Network fears the change will “lead to poorer health outcomes.”
They’re right. CMS’ changes risk the lives of millions of American seniors.