WASHINGTON, D.C. – Following a proposed change in Medicare policy that would have limited access to lifesaving drugs for seniors, U.S. Sen. Sherrod Brown today introduced bipartisan legislation to preserve Medicare access to six classes of critical prescription drugs. Brown’s Medicare Formulary Improvement Act, introduced today with Sen. Chuck Grassley (R-IA), would make sure that antidepressants, anticonvulsants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants remain protected under Medicare’s prescription drug plan, Medicare Part D. Drugs in these categories are critical to the treatment and maintenance of a wide-range of diseases and illnesses including mental illnesses, HIV/AIDS, cancer, epilepsy, and transplants.
“For many years, Medicare has ensured that seniors enrolled in prescription drug plans can easily access critical drugs that treat sensitive diseases and health conditions. This bipartisan bill will ensure that seniors don’t have to jump through hoops like prior authorization to access the prescription drugs they need,” Brown said. “We know access to the right drugs saves lives and costs, and any changes to Medicare’s prescription drug plan must not jeopardize patient choice and safety.”
Long-standing Medicare policy has provided protected class status for the six categories of protected drugs. Medicare Part D also prevents “step therapy” – a process that requires patients to try multiple low-cost drugs before gaining access to the drug they wanted in the first place – and prior authorization for drugs in these categories.
Last year, the Centers for Medicare and Medicaid Services (CMS) sought to change current policy to limit access to three of these protected classes of drugs. This would have allowed Medicare Part D plans to cover fewer drugs, providing beneficiaries with limited options. But for many seniors who rely on the prescription drugs in these classes, it is especially important for patients to have access to the specific drugs that they and their physician have found work for them – generic or brand name. Following a letter from Brown and the entire Senate Finance Committee, CMS rescinded its proposed change last year, ensuring continued access to these critical drugs for Medicare Part D recipients. Brown’s bill is necessary because it will codify these regulations to ensure that CMS cannot make changes like this that would jeopardize patient access to these drug classes in the future.
When beneficiaries lack access to needed medication, patients, hospitals, and taxpayers are faced with additional costs due to avoidable hospitalizations, physician visits, and other medical interventions that are preventable with proper adherence to medication.
“Patients with chronic and life-threatening illness face frequent and complex treatments decisions. Ensuring continued coverage for therapies that are most closely aligned to the very personalized needs of patients is something we should all support, and we are grateful for Senator Brown’s support.” stated Michelle Johnson, Executive Director, Cancer Support Community of Greater Cincinnati & Northern Kentucky.
“Thanks to the leadership of Senator Brown, Medicare will continue to provide beneficiaries with the options most closely aligned with their individual health needs as determined by the patient and the health care team. We encourage Congress to swiftly advance this important measure,” said Bev Soult, President & CEO, Cancer Support Community Central Ohio.
“The Epilepsy Foundation strongly supports the legislation introduced today by Senators Grassley and Brown, and is grateful to their understanding and compassion for those Medicare patients who rely on access to protected classes of medication. We strongly urge the Senate to take up this legislation and act on it immediately so that there can be no future regulatory changes that could create harmful barriers to patient care,” said Kathy Schrag, Executive Director, Epilepsy Foundation of Greater Cincinnati and Columbus.
Dr. Joseph Calabrese, Director, Mood Disorders Program, University Hospitals Case Medical Center in Cleveland and a member of the Depression and Bipolar Support Alliance Scientific Board, sees this legislation as important for saving lives. “Approximately 35 to 40 percent of Americans will experience a mental health condition during their lifetime. Based on my 30 years of experience I can predict with very high certainty that imposing limitations to care, such as restricted formularies, will result in a dramatic increase in attempted and completed suicides.”
“We applaud Senators Grassley and Brown for initiating legislation to maintain safeguards for access to life-saving medications in these six protected classes under Medicare Part D. Individualized care, tailored to the unique needs of the patient, is essential in treating complex and chronic physical and mental health conditions. This legislation assures patients and their health care providers that they can access the medications needed to manage the patient’s physical and mental health conditions to achieve health, wellness, and recovery,” said Hubert Wirtz, CEO, The Ohio Council of Behavioral Health & Family Services Providers.