CMS reverses decision on Medicare prescription rules

March 21, 2014

Strenuous protests from family physicians and others have led CMS to reverse its decision on proposed changes to the Medicare Part D prescription drug program. The AAFP was among a number of organizations that oppose the rule, saying that the proposal would restrict patients' access to necessary medications.

The CMS proposal would have removed antidepressants and antipsychotics from the list of medications that are required to be included in all Part D formularies. Medicare formularies have included six protected drug classes (anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants for the treatment of transplant rejection) since 2005, and the AAFP opposes any changes to their status that could limit a patient's access to physician-prescribed medications.

“The (proposed) changes in 2015 to the antidepressant and antipsychotic classification are particularly troubling to the AAFP since primary care physicians make the majority of depression diagnoses and prescribe more than half of all antidepressants,” said AAFP Board Chair, Jeff Cain, M.D., of Denver, in the Academy's Feb. 26 letter to CMS Administrator Marilyn Tavenner.

Mental health patients often receive prescriptions for several antidepressants, and finding medications that do not negatively interact with each other is difficult, Cain noted.

The proposed rule was intended to reduce costs by an estimated $1.3 billion from 2015-2019. The rule is part of implementation efforts associated with the Patient Protection and Affordable Care Act and was expected by the medical community.

While acknowledging that the proposal was made based on the cost of drugs and their usage rates, the AAFP argued that limiting some prescription drugs that were part of regular treatment could end up increasing the cost of care. Cain pointed to research from the American Psychiatric Institute for Research and Education indicating that the expected number of ER visits was 74 percent higher for Medicaid patients with reported medication access problems.

Members of the Senate Finance Committee also voiced concerns about the proposed changes. They noted in a letter to CMS that the changes could hinder what was an effective program and reduce the quality of care for seniors.

In response to a cavalcade of criticism regarding the proposed changes to Part D drug classifications, CMS announced on March 10 that it was dropping that change.

“In particular, we heard concerns about the proposals to lift the protected class definition on three drug classes, to set standards on Medicare Part D plans' requirements to participate in preferred pharmacy networks, to reduce the number of Part D plans a sponsor may offer and clarifications to the noninterference provisions,” said Tavenner in a letter to Congress. “Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time.”

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