Medicare Changes Could Limit Access To Some Prescription Drugs

Proposed changes to some Medicare prescription drug plans are causing concern among patients with serious health conditions.

The Trump administration’s proposal to modify Medicare Part D and Medicare Advantage is intended to lower drug prices. But patient advocates say the changes could have significant consequences for people with serious illnesses.

In order to get their message out, advocates have taken out full-page advertisements in newspapers across the country. One such ad ran in recently in the Tampa Bay Times.

The changes involve the six protected classes of drugs under Medicare that help ensure access to expensive drugs to treat conditions like mental illness, AIDS, cancer, epilepsy or organ transplants. The protection makes sure Medicare beneficiaries are able to get the drugs that doctors prescribe to them without interference from prescription drug plans

The change would give drug plans more flexibility to manage patients’ use of drugs within the six protected classes. Proponents say it would stop guaranteeing that certain drugs are covered even when their prices skyrocket.  

One part of the proposal would allow insurers to make patients try lower price drugs before they are able to switch to more expensive options.

That could be dangerous for mental health patients who rely on antidepressant or antipsychotic prescriptions, said Jennifer Snow, director of public policy for the National Alliance on Mental Illness.

“This option has the potential to have really negative impacts on some of the most vulnerable Medicare beneficiaries,” Snow said. “This is not the right way, not a smart way to help lower drug costs.”

Snow’s organization filed a comment urging the Centers for Medicare and Medicaid Services not to adopt the proposal. The agency received more than 7,800 public comments by the January 25 deadline. It is now considering those comments before making a decision.

Other proposed changes would allow Part D plans to exclude new drug formulas of an existing drug and exclude drugs based on cost increases. 

“We’re just concerned about the impact that these will have on people who rely on medications to keep them stable,” Snow said.

Taking patients with severe mental health conditions off a drug that is working to try a cheaper drug could be dangerous, she said.

“We know what happens to people with mental illness when they go off their medication. Really negative things can happen. They can end up on the street. They can end up in jail,” Snow said. “To the extent that we can, we want to keep people having access to the treatment that works for them and get them on the road to recovery.”

The Centers for Medicare and Medicaid services has not set a timeline for a decision on the proposed changes.

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