Medicare Officials Back Away From
Changes to Prescription Drug Plan
By Mary Agnes Carey, Kaiser Health
News, Capsules: The KHN Blog
March 10, 2014 -Facing heavy bipartisan opposition on Capitol
Hill as well as from patient groups, businesses, insurers and others,
the Centers for Medicare & Medicaid Services saidMonday it did not plan to move ahead “at this time” with
several proposed changes to the Medicare prescription
regulation, which had been released in January, would have
wide-ranging impact on the drug program, also known as Part D, including
new limits on the number of plans insurers could offer consumers and new
rules about what drugs those plans must cover. It also would prohibit
exclusion of pharmacies from a plan’s “preferred pharmacy network” as
long as the pharmacies agreed to the plan’s terms and conditions.
During the rule’s comment period,
which closed March 7, CMS received “numerous concerns about some
elements of the proposal” from lawmakers and stakeholders, CMS
administrator Marilyn Tavenner said 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,” Tavenner said, adding that the agency will “engage in
further stakeholder input before advancing some or all of these changes
in these areas in future years.”
The agency will, however, move
forward with other elements of the rule, she said, including those
aimed at ensuring access for beneficiaries during natural disasters,
reducing fraud and broadening the release of Part D data that does not
Currently, Medicare has six
protected drug categories. CMS
proposed to eliminate two of those starting in 2015 with
antidepressant drugs and those that help suppress the immune system. The
agency also said in the draft rule that it was considering dropping
protected status for antipsychotic drugs in 2016. Lawmakers in both
parties and representatives of patient groups
pushed back loudly, saying that making those changes could stop
patients from getting the drugs they need.
CMS maintains that safeguards in
current law will ensure that patients receive necessary medications, and
point out that 140 other classes of drugs are offered through the
prescription drug program, even though they are not covered by protected
status. CMS also says that special status hurts the prescription plans’
ability to negotiate discounts with drug makers.
Another element of the proposed
rule would allow insurers to offerno more than two prescription
drug plans – one basic plan and one enhanced – in the same service
area. The health law’s ongoing closing of the Part D “doughnut
hole,” the gap in coverage where seniors pay the full cost of
coverage before the plan’s catastrophic cap kicks in, “has reduced the
need for plans offering enhanced benefits,” according to CMS.
The agency says that each region of
the country now has on average nearly three dozen plans and reducing
that would help give beneficiaries more clarity about the differences
among plans. Critics of the proposal said it would limit seniors’
choices for coverage.
CMS’ plan was attacked on several
fronts. A coalition of more than 370 groups representing seniors,
patients, health care providers and employers
wrote a letter to Tavenner in opposition. A bipartisan majority of
the Senate Finance Committee
told Tavenner they were “perplexed as to why [CMS] would propose to
fundamentally restructure Part D by requiring immediate, large-scale
changes to the program that have direct consequences for
Republicans on the House Energy and
sounded similar concerns. And, Rep. Renee Ellmers, R-N.C., a member
of the House leadership team, introduced
legislation that would stop CMS from moving forward with the rule’s
prescription drug provisions. The bill is scheduled for a floor vote
Rep. Sander Levin of Michigan, the
ranking Democrat on the House Ways and Means Committee, said the
administration’s decision to not “finalize the most controversial
proposals in the Part D proposed regulation shows they have listened to
stakeholder comments.” He suggested that Ellmers’ bill “would be a gross
Some congressional Democrats,
facing a tough midterm election battle, were nervous that a
battle on changes to the Medicare drug program could make them even more
Republicans have made repeal of
President Barack Obama’s health care law central to their campaign to
take control of the Senate and keep the House in the fall elections. The
idea of eliminating some Part D plans because they are duplicative of
current offerings — CMS’s rationale for the proposed change — has helped
Republicans revive criticism ofthe president’s “if
you like your plan you can keep it” pledge on the health law.
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