Action Needed to Protect Medicare

Medicare Part D provides drug coverage for 43 million seniors and adults with disabilities, including many people with mental illnesses. Currently, Medicare Part D and Medicare Advantage plans must include “all or substantially all” of the medications in six protected classes, which include antidepressants and antipsychotics. These six protected classes were created to ensure people with conditions treated by these medications are not discriminated against, as well as to ensure access to a range of options that meet individual needs.

But there is a proposal that could hurt these protections.

Late last year, the Centers for Medicare and Medicaid Services (CMS) proposed a number of changes to how Medicare pays for drugs. NAMI is concerned by a proposal that would allow plans to use prior authorization and step therapy more widely in the six protected classes, even for people who are stable on their current medication.

NAMI opposed this rule change in comments submitted last month. Over 7,000 comments were submitted from across the country, including by many of you. NAMI also worked with a bipartisan group of Representatives on a letter to CMS requesting that they not make this rule change.

And just this week, U.S. Health and Human Services Secretary Alex Azar, who oversees CMS, said “I was very disturbed to hear that patients switching among insurance plans, like switching among Medicare Advantage plans, can often be required to start over again on a step therapy regimen. […] This is not just potentially injurious to their health; it’s also penny-wise and pound-foolish.”

We couldn’t agree more.

Every voice is critical to make sure protections for the six protected classes are not weakened. U.S. Senators Marco Rubio (R-FL) and Kyrsten Sinema (D-AZ) are encouraging their Senate colleagues to sign onto a letter to the Administration asking CMS to maintain the six protected classes policy in Medicare Part D. NAMI Minnesota will be reaching out to our two U.S. Senators to ask them to sign on to the letter. We’ll keep you posted.