Final Part D Rule Protects Access – For Now

June 9, 2014

by Amanda Conschafter, Blog Editor

Medicare beneficiaries and patient advocates breathed a collective sigh of relief last month when the Centers for Medicare and Medicaid Services (CMS) issued its final Part D rule – which targeted program abuse instead of implementing cost-cutting restrictions on medication access. But during a recent Medicare Today national tele-town hall, panelist and U.S. Representative David Scott (D-GA) still advised attendees to “make noise.” Rep. Scott and fellow panelist U.S. Representative Kyrsten Sinema (D-AZ) say only continued vigilance and public input can convince CMS to reject these provisions – currently “on pause” – permanently.

Reiterating her commitment to keeping Medicare strong, Rep. Sinema cited high Medicare Advantage participation rates in her district and “extraordinarily high” satisfaction rates. Sinema, who recently introduced the bipartisan Strengthening Healthcare Options for Vulnerable Populations Act, emphasized the need to focus on “long-term value instead of short-term costs.”

But keeping a broad perspective may prove challenging for policymakers. As Rep. Scott explained, an array of outside factors affect Part D policy. Medicaid expansion and even tax reform can trigger cuts to Part D, Rep. Scott noted, as more government programs vie for a finite pool of resources.

Rep. Scott likewise expressed concern about insurers who refuse Medicare beneficiaries coverage for specialty drugs or biologics without consulting their health care providers. Rep. Scott described the practice as “dangerous” and agreed to follow up on the issue, introduced by a town hall attendee.

Panelists and their moderator expressed concern that the proposed changes will re-emerge in future rulings. Crediting public outcry and lawmakers’ appeals with halting CMS’ original proposal to limit plans and drug options, town hall participants urged ongoing advocacy to keep Part D robust.

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