CMS’ Decision a Good Call for Patients

CMS’ Decision a Good Call for Patients

03.20.14 | By John Castellani

In January, the Centers for Medicaid and Medicare Services (CMS) issued a proposed rule that would have adversely altered Medicare Part D’s six protected classes for prescription medication, restricting Medicare beneficiary access to antidepressants and immunosuppressants beginning in 2015.

The proposed rule was met with an outpouring of concern about the effect these changes would have on Part D beneficiaries, causing CMS to reconsider the rule.

Before CMS announced it would not pursue changes to the program, we asked experts to share how they thought patients would be affected by the proposed rule on our Conversations forum. Specifically, we asked:

If implemented, what would the recent proposed changes to Medicare Part D’s six protected classes mean for patients?

Based on our contributors’ responses, CMS’ decision to not change the six protected classes is a win for patients.

The Depression and Bipolar Support Alliance, for example, was concerned that changes affecting patients’ access to certain antidepressants would be a step in the wrong direction in treating mental health. The organization’s president, Allen Doederlein, emphasized the point noting that the proposed changes would have had “severe human, economic, and societal consequences” for people with mental health conditions, as well as their families, friends and communities.

While the proposed changes to the six protected classes would not have directly affected antiretroviral and anti-convulsant treatments, advocates for epileptics and individuals with HIV/AIDS were nonetheless concerned one day they might. Carl Schmid, Deputy Executive Director of The AIDS Institute, and Angel Ostrom, Vice President of Public Policy and Advocacy for the Epilepsy Foundation, argued the proposed rule would have set a dangerous precedent and open the door to new curbs on patient options.

Given the overall popularity and success of Part D, Healthcare Leadership Council President Mary Grealy expressed concern around making unnecessary changes to the program. According to Mary, the proposed changes would have “fundamentally transform[ed] the market-based competitive model that has made the Part D program highly successful.”

Members of Congress who opposed the rule should be commended for taking the concerns of patients, providers, advocates, and caretakers seriously.  Their efforts contributed to CMS rethinking changes to Part D. This is a tremendous example of how the many facets of the health care ecosystem – including legislative and regulatory entities – can work together to improve patient outcomes.

I want to thank our Conversations contributors, not just for sharing their thoughts with us this week, but for speaking on behalf of patients. 


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