A Complete Retreat: “Protected Classes” Stay Protected In US Medicare
CMS has abandoned its plan to give private plans more leverage in the “protected” drug classes in Part D. It will probably be a long time before anyone tries to change the protected classes again.
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A decision made more than 15 years ago by CMS to require drug insurance plans to cover all drugs for six specific diseases has proven impervious to change. But will the protected classes remain if Part D is reformed more broadly?
Concerns about reducing patient protections will resonate with the Biden Administration and the Medicare Part D protected classes aren’t major cost drivers anyway, Avalere’s Mendelson says.
If not reversed by the Biden Administration, demo program that puts plans at increased risk in catastrophic phase would also enhance negotiating leverage for drugs in the protected classes.