Will Medicare Patients Lose Key Protections?

March 4, 2021

There’s a public policy time bomb ticking that threatens to disrupt essential drug coverage for millions of vulnerable Americans.

The threat comes from last-minute changes proposed by the Trump administration that could affect patients’ access to drugs in Medicare Part D’s six protected classes. Until now, the policy has required Part D health plans to cover “all or substantially all” drugs in the protected classes, safeguarding patient access and protecting continuity of care. These include drugs such as anticonvulsants, antidepressants and antipsychotics. The new policy would limit access by stripping that coverage requirement for insurers that participate in its “payment modernization model.”

Instead, these participating insurers would be allowed to cover just one drug per class. The sweeping change will affect patients with a range of complex conditions, including epilepsy, movement disorders, HIV-AIDS, cancer and mental illness. It would also affect organ transplant patients. 

Stripping medication access from millions of patients could save the agency money in the short term, but the long-term implications could be severe. Patients’ lives will be interrupted by emerging symptoms. Well managed diseases may spiral out of control. 

The Movement Disorders Policy Coalition, for example, warned that curtailing the protections would harm patients with Parkinson’s disease and Huntington’s disease, among other conditions. Preserving access to the range of medications that treat co-occurring mental health conditions is of paramount importance to these patients’ wellbeing.

The coalition is among the more than 100 patient groups that petitioned the Biden administration to stop the coverage rollback before it takes effect.

This isn’t the first time the six protected classes have been on the chopping block. The Trump administration suggested similar changes as part of the American Patients First blueprint in 2018. And the Obama administration once suggested eliminating some protected classes. Both proposals were deeply unpopular and ultimately abandoned.

Reducing longstanding medication access protections for millions of patients shouldn’t be done hastily. And any changes should be introduced in a forum that allows for public input. Now, it’s up to the Biden administration to defuse this situation before it causes irreversible harm.

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