More Than 200 Groups Urge CMS To Withdraw Proposal on Part D Benefit

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By Mindy Yochelson  

Feb. 19 --Proposed changes to Medicare's prescription drug program would negatively affect beneficiaries and the companies that serve them and should be withdrawn, more than 200 groups told the Centers for Medicare & Medicaid Services in a Feb. 18 letter.

“We urge you in the strongest terms to withdraw the proposed rule that would have unintended consequences for seniors and beneficiaries with disabilities,” the groups said. “Weakening these programs will result in a less healthy patient population and, consequently, increased Medicare costs in the long term.”

The 236 organizations included health plans and various consumer and medical groups, such as Easter Seals, America's Health Insurance Plans, Blue Cross and Blue Shield Association, American Osteopathic Association and the Pharmaceutical Care Management Association.

The letter was distributed by the Healthcare Leadership Council (HLC), which describes itself as a coalition of chief executives of health-care companies and organizations.

The CMS said the proposed rule, which would make technical and policy changes to Part D and the Medicare Advantage program, mostly in 2015, would save $1.3 billion between 2015 and 2019. It was published in the Jan. 10 Federal Register (79 Fed. Reg. 1,917).

Protected Classes

The provision that has generally sparked the most animus would eliminate categories of drugs from the protected class requirement.

According to the groups' letter, the proposal “would fundamentally transform the market-based competitive models that have made the Part D program highly successful.”  


Under the CMS proposal, the antidepressant and immunosuppressant drug classes would no longer have protected status, which requires that all or substantially all of those products be included on Part D plan formularies.

The CMS also said that antipsychotics would remain protected at least through 2015, while it evaluates additional considerations

According to the groups' letter, the proposal “would significantly reduce beneficiaries' choice of plans and medicines and lead to disruptions in care.”

As a result, it said, “Millions of seniors and beneficiaries with disabilities would lose their current plan of choice or face changes in coverage.”

Proposal Attracts Comments

The letter was one of more than 1,300 comments received as of Feb. 18.

On Feb. 19, three Republican lawmakers wrote to Health and Human Services Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner expressing strong opposition to the proposal , which they called “bureaucratic overreach into a highly functioning marketplace.”

In their letter, Sen. Orrin Hatch (R-Utah), ranking member of the Senate Finance Committee; Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee; and Rep. Dave Camp (R-Mich.), chairman of the House Ways and Means Committee, warned that “a failure to reject this rule will force Congress to evaluate all legislative options necessary to ensure seniors are protected.”

The three, who describe themselves as “authors of Medicare's successful prescription drug program,” particularly objected to limitations on the number of plans and agency interference in negotiations between plans and pharmacies.

Hatch also signed on to a letter from the entire membership of the Senate Finance Committee, which also asked that changes be rejected .

Timing Creates 'Great Uncertainty.'

The proposal was published five months before the CMS's June 2 deadline for submission of 2015 plan bids.

The “timing of this omnibus proposed rule has created great uncertainty as many of our organizations and the companies we represent have already begun preparations for the 2015 plan year,” the 236 organizations said. “With the June bid submission deadline in mind, we urge you to withdraw the proposed rule in a timely manner in order to minimize disruption for beneficiaries when it comes time to make plan selections in October.”

The proposal, according to the groups' letter, “would fundamentally transform the market-based competitive models that have made the Part D program highly successful.”

HLC Executive Vice President Michael Freeman told Bloomberg BNA Feb. 19 that the provision to limit stand-alone prescription drug plan sponsors to no more than two plans per PDP region is one way that this might happen.

“Today, Medicare beneficiaries in every state enjoy a wide range of Part D plans from which to choose, and this competitive system has succeeded in maintaining affordability for both Part D consumers and for taxpayers,” Freeman said.

The letter also said that the proposed rule “would dramatically expand the federal government's role in Medicare Part D despite the fact that there is no compelling reason for doing so.”

Freeman said that this refers, in part, to the provision that would require drug plan sponsors to contract with any willing pharmacy able to meet the terms and conditions offered by that plan for that type of pharmacy.

Preferred pharmacy networks “have succeeded in making drugs more affordable for beneficiaries,” he said.

Imposing Costs

Further, the letter said that the proposed regulation would “impose a large cost burden that will impede the ability of plan sponsors and other health sectors to continue offering affordable, quality care to patients.”

According to Freeman, “there are a number of ways in which plans will incur greater costs, from increased self-auditing requirements to federal micromanagement of mail-order drug delivery time frames to new requirements on plans to verify that Part D prescribers meet specific criteria.”

The comment period on the proposal closes March 7.


To contact the reporter on this story: Mindy Yochelson in Washington at

To contact the editor responsible for this story: Ward Pimley at

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