Avoiding a Dangerous Precedent

The protest over proposed changes to the federal prescription drug benefits highlights the program’s success.

One of the greatest examples of a public-private collaboration that really works in the interest of people, health care and the economy is the Medicare Part D prescription drug program. Despite it’s enormous popularity with users and extreme efficiency—saving healthcare tens of millions of dollars each year—uninformed and ill-advised policy makers were committed to changing it.

After a number of petitions and letters of protest by lawmakers and physician groups, the Centers for Medicare and Medicaid Services (CMS) changed its course on several proposals that would have affected Medicare prescription drug benefits.

One of the changes proposed earlier this year would have reduced patient access to three protected therapy classes included in Part D coverage—antidepressants, antipsychotics and immunosuppressants. The changes were an attempt to reduce overall healthcare costs by $1.3 billion over five years.

“By proposing this rule, regulators are signaling to patients, providers and the American people, that the government can make unilateral decisions that limit treatment options for those who gain health insurance coverage through a government program,” Howard Dean, former governor of Vermont and Democratic National Committee chairman, wrote in an article for the Huffington Post.

This is a dangerous precedent, not only for the elderly and uniquely vulnerable populations the rule will impact immediately, but also for the millions who will soon rely on government-guided plans under the [Affordable Care Act].

Since 2005, Medicare Part D prescription coverage has included six protected drug classes: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals and immunosuppressants. The CMS created these classes “to ensure that Medicare beneficiaries reliant upon these drugs would not be substantially discouraged from enrolling in Part D plans.”

At the moment, over 36 million Americans are enrolled in Part D plans, with about 63 percent—around 22.7 million people—signed up in prescription drug plans, according to the Kaiser Foundation. Overall, Medicare Part D is enjoying enormous popularity; an analysis of the 2010 survey found that 94 percent of Part D enrollees are satisfied with their benefits and 95 percent believe their coverage meets their needs.

In a letter to CMS Administrator Marilyn Tavenner, critics stressed that the measures would have restricted patient access to necessary medications. Numerous health organizations have argued for the need to maintain coverage of the six classes to preserve drug combinations to treat such a diverse range of beneficiaries.

“Some patients may experience harmful side-effects with a particular drug combination that might work wonderfully for someone else,” the National Kidney Foundation said in a statement. “It takes a delicate balance to properly suppress the immune system in order to preserve the organ, while minimizing side-effects for each patient.”

The proposed changes were considered to reduce costs, but Medicare Part D has already been doing just that. According to an analysis of the Congressional Budget Office data, Medicare Part D has cost 45 percent less than the initial 10-year projections, according to CBO data. That equates to a savings of $348 billion.

“Medicare Part D, including the Six Protected Classes, is working. Beneficiaries, including those with HIV, are able to access the medications that their doctors prescribe,” Carl Schmid deputy executive director of the AIDS Institute, said in a statement. “We don’t understand why the Obama Administration would propose to diminish that access.”

In fact, recent studies have shown that expansions of drug coverage under Part D have led to large cost-savings. For example, a report published in the American Journal of Managed Care found that access to medications reduced medical expenditures by $2.6 billion annually among Part D beneficiaries diagnosed with congestive heart failure.

“This is a dangerous precedent, not only for the elderly and uniquely vulnerable populations the rule will impact immediately, but also for the millions who will soon rely on government-guided plans under the [Affordable Care Act],” continued Dean in his article.

Indeed, although the proposed rule changes would have mainly affected the mental health and organ transplant communities, it also would have set a dangerous precedent for all who depend on Part D drug plans to manage their diseases.