Movement Disorders Patients Need Medicare’s 6 Protected Classes Intact
February 19, 2019
Add movement disorders patients to the long list of people whose health could suffer under the Trump administration’s proposal to loosen Medicare protections on six classes of medications for high-risk diseases.
In current practice, Medicare prescription drug plans must cover all (or “substantially all”) drugs in six classes. These include drugs for life-threatening conditions such as cancer, epilepsy or HIV. It also includes medications for mental health.
As envisioned by a recent Centers for Medicare and Medicaid Services’ proposed rule, however, plans could select which of these drugs they cover – and how favorably they cover them. Plans could introduce step therapy or prior authorization to drive patients toward the medication with the lowest negotiated price, even if that’s not the medicine the patient needs.
Officials estimate that the change could produce big savings for the federal government. But the implications for patient health are jarring, particularly for patients with movement disorders such as Parkinson’s, Huntington’s, Tourette’s disease or essential tremor. In addition to the physical challenges these patients face, they can also experience mental health conditions or clinical symptoms such as depression, anxiety, or – in the case of Parkinson’s patients – psychosis.
Managing mental health equips these patients to deal with the daily challenges imposed by their physical symptoms. To do so, these patients likely have worked with their health care provider to identify a therapy that addresses symptoms while minimizing side effects and interaction with other medications. If health plans’ cost-cutting measures make it difficult or impossible to continue accessing these therapies, patients would feel the consequences.
As the nonprofit Movement Disorders Policy Coalition explained in a letter to CMS, “For movement disorders patients already facing complex conditions and treatment regimens, delays and interruptions in care can be dangerous. These patients need clear, continuous access and the ability to stay on the treatment course that is working for them.” The organization called upon CMS to retain current policy on the six protected classes.
Many other patient advocacy groups have spoken out against the proposed rule, including the American Cancer Society Cancer Action Network, The AIDS Institute, Mental Health America, The National Kidney Foundation and the Alliance for Patient Access.
The public comment period on the proposed rule closed January 25. Now patients, providers and health care advocates wait to see what CMS does next.
Tags: Neurological, Regulatory IssuesCategorized in: Blog