Cutting Patient Protections to Cut Costs?

The Trump administration proposed that reducing guaranteed coverage of certain drugs for Medicare beneficiaries would lower costs. The coverage requirement has been in place since 2006 and includes six protected classes: antidepressants; antipsychotics; immunosuppressant and anti-epileptic drugs; antiretrovirals; and many cancer drugs. Under the new plan, if a drug sharply increases in price, Medicare is no longer required to cover it. In addition, Medicare drug plans could require patients to try cheaper alternatives or seek prior authorization before their prescriptions are filled.

Proponents of the plan believe it will lower out-of-pocket spending for Medicare beneficiaries and allow the agency more leverage to negotiate deals with drug makers. “President Trump is following through on his promise to bring tougher negotiation to Medicare and bring down drug costs for patients,” Secretary of Health and Human Services Alex M. Azar told The New York Times.

However, critics argue that the proposal would limit access to drugs for HIV, schizophrenia, and other chronic conditions that vulnerable patient populations desperately need. “The Trump administration proposal is bad medicine and dangerous to people living with HIV,” Carl E. Schmid II, deputy executive director of the AIDS Institute, told The New York Times. “The Medicare Part D program is working well for people with HIV, and there is no reason to take these draconian actions.”

Federal officials said Medicare Part D recipients will not be adversely affected, and, ultimately, the changes will expand access.

The change would take effect in 2020.

Source: The New York Times, November 26, 2018.