Administration retreats on Part D changes

Washington Watch

The White House, after an aggressive pushback from seniors, patients, pharmaceutical companies and lawmakers from both parties, recently scrapped most of a proposed plan to limit Medicare coverage for certain classes of drugs including those used to treat depression and schizophrenia.

In January, the Centers for Medicare and Medicaid Services proposed broad changes to the Medicare Part D prescription-drug program that covers medicines for about 39 million beneficiaries. Medicare officials had said the proposal would save money and reduce the overuse of drugs. But it created political problems for the White House, with some Democrats joining Republicans in denouncing the changes, saying they would harm Medicare beneficiaries.

Since its inception in 2006, the federal government has required Medicare’s insurers to cover “all or substantially all” drugs in six treatment areas. The administration proposed in January to lift the requirement for three types of medications: immunosuppressant drugs used in transplant patients; antidepressants; and antipsychotic medicines, used to treat schizophrenia and certain related disorders.

But in a letter to lawmakers, Marilyn B. Tavenner, the administrator of the federal Centers for Medicare and Medicaid Services, said officials would not pursue the proposal. “Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time,” she said.

Tavenner also decided to hold off on three other proposals. One stipulates that insurers can offer no more than two prescription drug plans to Medicare beneficiaries in the same region. Another would give patients greater access to small community pharmacies by requiring insurers to offer contracts to any retail drugstores willing to accept their terms and conditions. A third would allow the government to intervene in negotiations between insurers and pharmacies.

Tavenner said the proposals would be shelved for now. But she said the agency would “engage in further stakeholder input before advancing some or all of the changes in future years.”

She added that the agency planned to proceed with other proposals in its January document related to consumer protections and anti-fraud provisions that have bipartisan support. The reversal came just one day before the House was scheduled to vote on a bill that would prevent officials from carrying out any part of the proposed regulation affecting drug coverage.

Also contributing to this article were: Kaiser Health News, Politico, New York Times, Wall Street Journal, Associated Press.

Rendered 07/16/2024 18:39