NYAPRS Note: The will of advocates has won out in Washington D.C., as CMS yesterday withdrew its proposal to remove three drug classes from the Medicare Part D prescription coverage. Those three drug classes included antidepressants and antipsychotics. This is a tremendous victory not only for Medicare recipients, but for other publically funded groups that may be suject to similar proposals in the future. HHS released a statement saying that it would not consider rewriting the proposal at this time given the strong stakeholder pushback. In NY, a bill in the legislature would seek to remove some prescriber prevails authority, and weaken the relationship between prescriber and consumer. NYAPRS is supporting full protection of provider prevails in NY, and know that other advocates across the state are lending their valued voice to protecting consumer choice.
White House Withdraws Plan Allowing Limits to Medicare Coverage for Some Drugs
NYT; Robert Pear, 3/10/2014
Under pressure from patients, pharmaceutical companies and members of Congress from both parties, the Obama administration on Monday withdrew a proposal that would have allowed insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia.
Medicare officials had said the proposal would have saved money and reduced the overuse of drugs. But it created political problems for the White House, with some Democrats joining Republicans in denouncing the changes, saying they would harm Medicare beneficiaries.
Since the start of Medicare’s prescription drug benefit in 2006, the government has required insurers to cover “all or substantially all” drugs in six treatment areas. The administration proposed in January to lift the requirement for three types of medications: immunosuppressant drugs used in transplant patients; antidepressants; and antipsychotic medicines, used to treat schizophrenia and certain related disorders.
In a letter to lawmakers on Monday, Marilyn B. Tavenner, the administrator of the federal Centers for Medicare and Medicaid Services, said officials would not pursue the proposal. “Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time,” Ms. Tavenner said.
She said the administration had also decided to hold off on three other proposals. One stipulates that insurers can offer no more than two prescription drug plans to Medicare beneficiaries in the same region. Another would give patients greater access to small community pharmacies by requiring insurers to offer contracts to any retail drugstores willing to accept their terms and conditions. A third would allow the government to intervene in negotiations between insurers and pharmacies.
The National Alliance on Mental Illness and the American Psychiatric Association, among others, had criticized the proposal to roll back the requirement for coverage of three of the six “protected classes” of drugs.
A top Medicare official, Jonathan Blum, defended the proposed changes at a congressional hearing on Feb. 26. The Obama administration reversed itself on Monday, just one day before the House was scheduled to vote on a bill that would prevent officials from carrying out any part of the proposed regulation affecting drug coverage.
Two Republicans, Representatives Tim Murphy of Pennsylvania, a clinical psychologist, and Renee Ellmers of North Carolina, a registered nurse, had demanded that the White House withdraw the proposal.
“Medications impact a person’s brain and body in unique ways,” Mr. Murphy said. “That’s why physicians and patients with serious mental illnesses often try different therapies until they find the right one.”
Senator Mitch McConnell of Kentucky, the Republican leader, said he was “pleasantly surprised to see the Obama administration backtracking on a number of proposals that would undermine the highly successful Medicare drug program.”
Senator Ron Wyden, Democrat of Oregon and chairman of the Finance Committee, also welcomed the administration’s decision to drop some of the Medicare proposals. In a letter to Ms. Tavenner last month, Mr. Wyden and 19 other committee members said the proposals would “disrupt care for millions of beneficiaries and unnecessarily interfere with a successful program.”
Steven C. Weiss, a spokesman for the American Cancer Society’s CancerAction Network, said: “The decision announced today is an important change. With one in four cancer patients experiencing depression, access to a comprehensive range of antidepressants is critical so that doctors can determine which medications work best for individual patients. Immunosuppressants are also important for bone marrow transplantrecipients, to help prevent transplant rejection.”