OPINION: Proposed change to Medicare Part D is a step toward healthcare rationing

OPINION: Proposed change to Medicare Part D is a step toward healthcare rationing

CMS Proposed Elimination of Six Protected Classes Harms Seniors’ Health Care


If you’re 65 years or older and not on an employee sponsored health care plan – you must be on Medicare.

The Centers for Medicare and Medicaid Services (CMS) recently proposed a change to Medicare Part D – the prescription drug program for seniors.

Medicare Part D is the most free market part of the Medicare system and is dramatically different from other Medicare programs. Basically, seniors can shop for a prescription drug plan offered by a private insurance company and pick the plan that fits their medical needs. Seniors pay a monthly premium and Medicare pays a portion towards the plan as well. Seniors can shop around and change their Medicare Part D plan every year. According to the Kaiser Family Foundation – seniors in Tennessee can choose from 29 different Part D plans.

The whole point of having Part D plans offered through a private marketplace is to give seniors a choice of plans offering a variety of benefits. Congress did not want to be too prescriptive and only required that a plan offer a minimum of two drugs in each therapeutic class of drugs. However, the medical community argued that the diseases served by six classes of drugs were so complex and life-threatening that unless all drugs available in those classes were offered, some seniors would be left behind. As a result, Congress required that all drugs in the six protected classes be included in each Part D plan.

The Six Protected Classes include: antidepressants, immunosuppressants, antipsychotics, antiretrovirals, anticonvulsants, and antineoplastics. These drugs help our most critical seniors who have had organ transplants, being treated for HIV/AIDS, have epileptic seizures, receiving cancer treatment or are under psychiatric care.

Today, CMS is proposing to eliminate the protections seniors have under the “Six Protected Classes policy” because they think they can save some money. Medicare Part D is one of the most efficient parts of Medicare. It’s worth noting that 91% of drugs prescribed under the Six Protected Classes are already lower cost generics. But those drugs do not work effectively for some seniors. There is no need to deny those seniors the help they need in order to save money.

It’s ironic that if you visit CMS’ website the first thing you see is, “We’re putting patients first.

We pledge to put patients first in all of our programs – Medicaid, Medicare, and the Health Insurance Exchanges. To do this, we must empower patients to work with their doctors and make health care decisions that are best for them.”

CMS’ proposed elimination of the Six Protected Classes does just that – inserts government more into the middle of the physician-patient relationship – not allowing the doctor to make health care decisions that are in the best interest of the patient.

Elimination of the Six Protected Classes policy could mean that patients are forced into what is known as Step Therapy, where a patient must first fail on cheaper drugs, before they can

receive the drugs their doctor believes they need. Or they may be subjected to a lengthy prior approval process. Most seniors would agree that their physician should be able to decide on the best course of drugs – and all of the latest and most effective drugs should be available to treat these life and death medical cases.

According to this piece by American Medical Association President, Dr. Barbara McAneny – prior authorization and all of its hoops and hurdles oftentimes delay treatment and in some cases can delay treatment so much that the patient ends up dying during the waiting period. These treatment delays are unconscionable and could soon be a reality for seniors on Medicare thanks to CMS’ proposed changes.

Per Dr. McAneny of the AMA, “To us, the cost containment argument rings hollow. Denying a prescription or test might save money in the short run. But when a patient must be hospitalized due to a lack of timely treatment, those cost savings will be wiped out many times over.”

As a social conservative – I, and many others, are pro-life from conception until we breathe our last breath. The last thing we need is government rationing care for seniors and choosing which patients get access to medications and life-saving treatment. After all, we’ve seen how rationing of care has played out in England. Patients oftentimes wait in long lines, have to get approval and are often denied care due to their age or condition. CMS’ proposal would move our country down a path towards England’s National Health System and that is a step in the wrong direction.

It’s not unreasonable to conclude that CMS’ elimination of the Six Protected Classes will lead to government overreach into seniors lives where care is denied. This concern is not hypothetical. During the Obama Administration a committee called IPAB was created at CMS to decide, based on cost, who should have treatment at the end of their lives. Commonly known as a “death panel,” only this year was that law repealed. At the end of the day – I trust physicians and patients to make the correct call instead of government bureaucrats.

Thankfully, Senator Marsha Blackburn has joined thirteen other U.S. Senators in a bipartisan letter to CMS Administrator Seema Verma – urging CMS to rescind their proposal to eliminate the Six Protected Classes. The letter states that CMS’ proposal would limit access for seniors to life-saving medications and put their health and well-being at risk by implementing prior authorization, step therapy and fail first policies.

Patsy Writesman

I urge Senator Alexander along with all of Tennessee’s Congressmen to join Senator Marsha Blackburn and others in a bipartisan effort in opposing CMS’ proposed change to the Six Protected Classes.


Patsy Writesman of Williamson County is a health care Speaker and consultant. Reach her via www.ManageHealthCareCosts.com

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