CMS tagged posts

Why the Six Protected Classes Should Be Protected

Susan Weinstein, JD
Editor in Chief, Care for Your Mind

The Trump Administration has proposed a new rule that would change Medicare Part D, removing the requirement that Part D prescription plans cover “all or substantially all” medications in six “protected” classes: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. Why does this matter to us?

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Medicare Part D Users are Feeling the Squeeze

If concerns about being able to retain access to the correct medications to treat their mood disorders was not enough, individuals utilizing Medicare Part D must also be concerned about whether or not they can even afford to take their prescribed medications.

When Medicare Part D took effect in 2006, it arrived with mixed reviews. Today, according to a survey conducted by Medicare Today, 86% of seniors say they are satisfied with their prescription drug plan. One reason they site for the satisfaction is that the costs are reasonable. Given the way things are trending however, the Center for Medicaid and Medicare Services (CMS) may see satisfaction dip.

Cost related non-adherence to medication protocols is growing. The inability to pay for costly medicines causes patients to stretch out their prescriptions by skipping or taking smaller doses than prescribed. In in a recent Health Affairs study, (Medication Affordability Gains Following Medicare Part D Are Eroding Among Elderly with Multiple Chronic Conditions) seniors experiencing four or more chronic conditions reported a cost-related non-adherence rise from a low of 14.4% in 2009 to 17% in 2011.

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Speak Out About Potential Reductions to Medicare Part D Benefits

Last Tuesday, September 30, DBSA participant Trudy Lapin shared her story during two Congressional briefings sponsored by the Partnership for Part D Access. Trudy used her time to explain to Congressional staff from both the House and the Senate why a proposed regulation by CMS to restrict access to medication that aids in the treatment of mood disorders is misguided. You can read Trudy’s statement below, and learn how you can share your story with your own elected officials.

Treatment is not one size fits all
Although I was first diagnosed officially with major depression in 1993, signs of that particular mood disorder appeared in childhood. While attending college, an over achieving pattern went into high gear. I elected a double major in French and English literature with a minor in secondary education. I graduated with highest honors; accepted a full fellowship to Yale Graduate School to pursue my doctorate in Romance Languages and Literatures; taught French language, literature, and film at Yale College and at the University of Chicago; and was awarded a National Endowment for the Humanities grant, where I enjoyed the privilege of working with humanities scholars at Princeton University.

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How Will You Protect Access to Quality Mental Health Care for Seniors?

Today the Partnership for Medicare Part D will hold a Congressional briefing to discuss the significance of Medicare’s “Six Protected Classes” policy giving seniors access to quality mental health care. While you may not be able to attend in person, it is still critical that you educate your Congressional Representative and Senators on the importance of retaining these benefits.

How Will You Protect Access to Quality Mental Health Care for Seniors?
According to the Geriatric Mental Health Foundation depression impacts more than 6 million of the 40 million Americans over 65. Health problems become more common and increasingly complex as seniors age. With the onset of more serious conditions such as heart disease, stroke, cancer, arthritis, Alzheimer’s disease, and Parkinson’s disease, individualized medicine becomes increasingly critical to helping seniors manage their mental and physical health.

This is why Congress carved out six protected classes of medications when they authorized Medicare Part D. Their intent was that seniors would have access to these medications without regulatory burdens. The preservation of the six protected classes is critical to providing treatment for serious, complex health conditions without delay or restricted access to essential treatment.

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