To families of individuals with developmental disabilities:
The Centers for Medicaid and Medicare want to change a policy that requires that Medicare Part D Prescription plans include all medications in six protected groups. These medication groups are protected for a reason. They are vital to individuals who need them. This will have a significant impact on individuals with developmental disabilities who receive both Medicare and Medicaid. The policy change applies to several of the groups of medications, and could signal the beginning of removing protections for all six groups of medications in the future. These groups of medications are for things like cancer, seizure medications, psychiatric drugs and HIV. Your family member may not have Medicare yet, but at some point in their lives, they may become dually eligible. Please consider protecting their future access to these medications and access for those now eligible by responding to The Arc's action alert below.
Karen Scallan
Parent Advocate
Special Needs and Parent Support Services of LA, LLC
Email: kcscallan@gmail.com
Twitter: @KarenScallan
Blog: http://parentperspectivesonmltss.wordpress.com
Oppose Language from CMS That Will Restrict Access to Important Medications for People with Disabilities
Oppose Regulatory Language from CMS That Will Restrict Access to Important Medications for People with Developmental Disabilities Who Receive Medicaid and Medicare (the Dual Eligibles)
Background:
The Centers for Medicare and Medicaid Services (CMS) is proposing to revise the long standing policy that requires Medicare Part D prescription drug plans to include on their formularies (the list of drugs covered by the plan) “all or substantially all” drugs within six classes:
- antidepressants (e.g., Prozac, Effexor, Zoloft) used for treating depression,
- antipsychotics (e.g., Risperdal, Zyprexa, Seroquel) used for treating psychiatric disorders such as schizophrenia and bipolar disorder
- anticonvulsants (e.g., Depakote, Tegretol, Lamictal) used for preventing or reducing seizures,
- immunosuppressants used to prevent the rejection of transplants,
- antiretrovirals used in the treatment of HIV and AIDS, and
- antineoplastics used to treat cancers.
This policy, known as the “six protected classes” policy, is an important consumer protection that has been in effect since the roll out of Part D. People who are Medicare beneficiaries or are dually eligible for Medicare and Medicaid receive their prescription drug coverage through Medicare Part D.
Impact:
CMS is proposing that antidepressants and immunosuppresants lose protected status in 2015 and anti-psychotic medications in 2016. This would likely mean that Medicare Part D prescription drug plans would not continue to cover all or substantially all of the drugs in these medication classes. People who require medication not on the drug plan’s list would have to either:
- pay out of pocket;
- change to a potentially less effective medication or a medication that may have additional side effects; or
- utilize the exceptions or appeals process to try to gain access to the drug (with no assurance that this process would be successful).
Prescription medications - particularly in the medication classes described in this Action Alert - are not interchangeable, and doctors prescribe treatments to meet the unique needs of each person. When the Medicare Part D program was initiated, these classes of drugs were protected because of concerns that Part D formularies would be restrictive and limit access to medications. CMS is proposing these changes to save money. However, it is highly likely that disrupting access to needed medications will be a threat to the person’s health and well-being and may lead to increased Medicare expenditures by resulting in more doctor visits, hospital emergency room visits, and hospitalizations.
What You Can Do:
Advocates and families must write to CMS and urge them to drop the language making changes to the antidepressant, antipsychotic, and immunosuppressant medication classes. Comments are due no later than March 7th. To provide comments electronically:
Document: Oppose Language from CMS That Will Restrict Access to Important Medications for People with Disabilities
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