Medicare is Under Attack… Again!

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Medicare is Under Attack… Again!

November 28th, 2018

Yesterday the Trump administration released a proposed rule that would change key parts of Medicare’s prescription drug program. In our initial reading of the proposed rule, there are two parts that, RetireSafe feels, need to be highlighted immediately. These proposed changes affect the six protected classes and step therapy and will have a huge negative impact on older Americans.

One of the important parts of Medicare was the regulation that protected six critical classes of medicine by requiring all drug insurance plans to include them in their formulary and did not require the doctor to go through step therapy before they could get access to the drug that their doctor, who best understands them and their illness, had initially prescribed.

It is important to remember that one of the reasons the designers of the Medicare drug benefit included the six protected classes was to keep insurance companies from excluding certain patients from their insurance plans. The drugs included in these protected classes were often expensive and associated with a “sicker” class of patient. If all the insurance plans were required to include these drugs in their formulary, they couldn’t cherry pick the “healthy” patients while refusing access to the “sick” patients. It was a way to make sure that these “sicker” patients had choices and, most important, access to these critical drugs.

The ban on step therapy guaranteed that bureaucrats couldn’t force patients to fail first on the insurance preferred drug before they were allowed to take a second drug, even if their doctor had initially prescribed the second drug. This ban was put in place so that the insurance companies couldn’t hold up treatment for these critical and often time sensitive diseases.

These two aspects of the Medicare drug benefit have worked for 13 years! The playing field was leveled and encouraged fair competition while guaranteeing timely access to critical drugs. The real question is  . . .  why change them now? If these changes will have such a positive impact why weren’t they changed five years ago? Why not ten years ago? It’s my opinion that it’s being done now, not because it benefits the patient, but because it is a knee jerk reaction to the pressure the administration is under to take some action on drug prices.

Older Americans, who have been confident that those drugs in the six protected classes would always be available no matter which drug plan they choose, no longer have that guarantee. The care delaying step therapy process will be a government induced road block that will have a real impact on the health of seniors.

This disingenuous and politically motivated change, to a part of Medicare that has worked for 13 years, is a real threat to the health of seniors and needs to be stopped. At the end of the day, the push to lower drug prices should really be a focus on lowering the out-of-pocket costs that seniors pay for prescription drugs and ensuring that they and their doctor have access to the drugs that are best for them.

RetireSafe will continue to fight for changes that truly accomplish these goals and will work to stop these Ill-advised changes the administration has proposed.