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Medicare Officials Back Away From Changes To Prescription Drug Plan

WebMD News from Kaiser Health News

By Mary Agnes Carey

Mon, Mar 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 said Monday it did not plan to move ahead “at this time” with several proposed changes to the Medicare prescription drug program.

The draft 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 identify beneficiaries.

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 offer no 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.

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