The Trump administration is pushing policies that threaten to undermine Medicare coverage for many of America’s most vulnerable seniors and people with disabilities. The worst of these misguided proposals could kill people. This might sound hyperbolic, but it’s not.
The Trump administration is seeking to put these policies in place through a Centers for Medicare and Medicaid Services (CMS) proposed rule released in November that, if finalized, will unravel long-standing coverage protections for six categories of illness, including cancer, HIV/AIDS and mental health.
Until now, the Part D plans that provide Medicare prescription drug coverage were required to cover most medications within those so-called “six protected classes” because the treatments are highly specialized.
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This is particularly troubling for patients whose existing regime will be disrupted by the change, forcing them to abandon effective treatments for less-effective options that Part D plans may prefer.
In some cases, this change could block patients’ access to the only effective therapy to treat their specific illness.
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Under this new proposal, patients who are finally stable on a medicine in the six protected classes would find themselves at risk for no longer having coverage for that medicine. This is because CMS will let insurance companies second guess doctors by forcing stable patients to prove they meet the health plan’s criteria for coverage of a drug. Health plans will also be allowed to force patients to fail first on one treatment before the plan lets them resume taking a medicine that has already been shown to work for them.
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CMS believes the shift will save money, but it could wind up costing the government much more by forcing patients into less-effective treatment plans before Medicare plans will cover the most effective medicine. And those disruptions can have catastrophic consequences if patients are forced off of their existing treatments just to prove other treatments are less effective.
Hundreds of prominent patient-advocacy groups have raised alarms about these proposals. “What is the point of having protected therapeutic classes, if they are not truly protected?” the head of the Community Oncology Alliance asked in a statement after the proposal was released.
The Hill
UPDATE:
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