Update

The Medicare Part D Payment Modernization Model

By March 1, 2021 No Comments

We urge our Oregon delegation to ask CMS to abandon the changes to the six protected classes in the PDM Model. The time is NOW for patients to access all the medicines they need and save money simultaneously.

To: United States Senate & United States House of Representatives

As community organizations and patient and disease groups, we are encouraged that Congress and the current Administration have made lowering our healthcare costs such a high priority.  Giving our members and patients access to the treatment they need to treat or cope with their disease at a manageable price for them will always be one of our top missions.

Many proposals are bouncing around Congress to meet the goal of lowering out-of-pocket costs. Many of them would make dramatic changes to Medicare. Some of these proposals have the patient in mind, while others, unfortunately, do not. We hope that as you work through them in the next few months, you will support the changes that encourage innovation while not harming beneficiaries’ access to care or treatment.

Unfortunately, the Trump administration announced last-minute changes to the Part D Payment Modernization Model that does nothing to lower out-of-pocket costs for patients while stripping protections for the six protected drug classes.

The six protected classes of drugs are the critical treatments of those patients struggling with mental illness, cancer, organ transplant rejection, and HIV. The categories are anticonvulsants, immunosuppressants, antidepressants, antipsychotics, antineoplastics, and antiretrovirals.

On January 19, 2021, the Center for Medicare and Medicaid Innovation (CMMI) launched the PDM Model to test a new Part D design voluntarily. The changes include removing protections for the six protected classes.

As of CY2022, participating Part D sponsors would be permitted to treat only five of the six protected classes – anticonvulsants, immunosuppressants, antidepressants, antipsychotics, and antineoplastics as they would other Part D drugs. As of CY 2023, CMS intends to remove protections for the sixth protected class – antiretrovirals.

Furthermore, as of CY 2022, regarding all other classes of drugs aside from the six protected classes, participating Part D sponsors would be permitted to include only one drug per drug class on their formulary rather than a minimum of two drugs per class, as is currently required.  As a result, many patients who require multiple medications within the six protected classes may lose access to their most needed drugs. In summary, we ask CMS to abandon the changes to the six protected classes in the PDM Model.

Please stand with patients and urge the Biden administration to immediately remove restrictive policies in the PDM Model. The time is NOW for patients to access all the medicines they need and save money simultaneously.

Sincerely,

Project Access NOW, Northwest Association for Biomedical Research, Cascade AIDS Project, Prism Health, Caring Ambassadors of Oregon, Oregon Rheumatology Alliance, and Oregon Bioscience Association

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