Trump Administration Backs Off a Proposal to Let Medicare Plans Exclude Certain Drugs
By Nicholas Florko Stat+ May 16, 2019
WASHINGTON — The Trump administration is backing off a controversial proposal1 to chip away at existing safeguards that require Medicare to cover all drugs for conditions like depression and AIDS.
The initial proposal, which would have allowed private Medicare plans to refuse to pay for certain drugs for chronic conditions that spiked in price, was met with widespread criticism almost as soon as it was proposed last November. The Trump administration had suggested the change would help lower drug prices by giving private Medicare plans more leverage over high-cost drugs. But patient advocates and drug makers said it would jeopardize patient care in life-threatening situations.
The policy was one of the first concrete drug pricing proposals the administration unveiled after it put out a sweeping and largely aspirational “drug pricing blueprint” earlier in 2018 — and its decision to roll back the idea is the first time the Trump administration has retreated on one of its drug pricing pitches.
“The agency appreciates the feedback received on this issue and has chosen not to finalize the proposed changes to its protected classes policy at this time, but rather is codifying existing policy,” a CMS press release stated.
Under current law, Medicare is required to cover “all or substantially all” drugs in six specific classes: 1) antidepressants; 2) antipsychotics; 3) anticonvulsants; 4) immunosuppressants for treatment of transplant rejection; 5) antiretrovirals; and 6) antineoplastics. The Trump administration’s proposal would have allowed private Medicare plans to not cover certain drugs in these categories when the drug had increased in price more than inflation, or in cases where it was a new version of an already covered drug.
HHS Secretary Alex Azar insisted when the proposal was first unveiled that it would “save money for taxpayers and seniors, improve access to expensive drugs many seniors need, and expand their choice of plans.”
But the idea inflamed drug makers and patient groups. So much so that the American Cancer Society’s advocacy arm and a coalition of other groups spent six figures on ads claiming the policy would “put patients’ lives at risk.”
“Medicare beneficiaries with the most complex, chronic conditions are breathing a sign of relief,” said Chuck Ingoglia, executive director of the Partnership for Part D Access, a coalition of drug makers and patient advocacy organizations that also opposed the proposal. “This rule cements Medicare’s protected classes policy as an essential patient safeguard in Medicare’s prescription drug program.”
The regulation released Thursday did, however, codify a number of other small tweaks to the Medicare drug pricing system, including a ban on so-called pharmacy gag clauses, which prevented pharmacists from telling patients when it’s cheaper to pay for a drug without insurance. Congress passed a similar law last year. Thursday’s final rule also set in stone a new requirement that paperwork sent from insurers to patients after a procedure must include information about drug prices.