Successful Outcome on Medicare Part D Reminds Us Why Advocacy is Important

POSTED BY

Alisha Martin

26 March 2014

By Chuck Ingoglia, Senior Vice President of the National Council for Behavioral Health

In January, the Centers for Medicare & Medicaid Services (CMS) surprised the patient and provider community when it issued a proposed rule seeking to make unprecedented changes to the successful and popular Medicare Part D drug program.   One of the most concerning of these proposed changes was the introduction of new criteria to evaluate the “drug classes of clinical concern,” most commonly referred to as the six protected classes.  These six “protected” classes of medications were identified by CMS during the implementation of the Medicare prescription drug benefit as needing special access for patients and providers, including drugs to treat mental illness, organ transplant, cancer, HIV and seizure disorders.

The proposal not only introduced new criteria, but it applied these criteria to the  protected classes and proposed removal of two classes in plan year 2015 – immunosuppressants and antidepressants – as well as removal in plan year 2016 for antipsychotics.  After hearing from patients, providers, legislators and the pharmaceutical industry, including the National Council for Behavioral Health and AstraZeneca, CMS announced on March 10th that it would abandon its recent proposal to strip mental health and immunosuppressant drugs of their protected status in Medicare Part D.


Chuck Ingoglia, Senior Vice President, Public Policy and Practice Improvement, National Council for Behavioral Health

CMS’ decision comes on the heels of an overwhelming outpouring of bi-partisan support that was the result of unified and swift advocacy.  In addition to the National Council and AstraZeneca, members of Congress, the Partnership for Part D Access, and other concerned patient and provider groups submitted well over 1,000 comments to CMS opposing the changes.  This reversal demonstrates the power of various sectors working together – providers, patients and industry.

The National Council and AstraZeneca applaud CMS for its decision not to finalize the proposed changes to the protected class policy.  This change will allow millions of the most vulnerable beneficiaries to continue to confidently rely upon Medicare to provide them the drugs they need.

CMS noted it will gather additional input and reserves the right to advance changes in these areas in future years, and this possibility necessitates ongoing vigilance and willingness to continue to work together on matters of common interest.  The National Council and AstraZeneca are committed to such a partnership to preserve patient access and choice within the Part D program.

Chuck Ingoglia is Senior Vice President, Public Policy and Practice Improvement for the National Council  for Behavioral Health. There he directs the federal and state affairs function and oversees practice improvement and technical assistance programs offered to more than half a million behavioral health professionals.