CMS Scraps Rule that Would Have Weakened Six Protected Classes


Aimed Alliance is pleased to announce that CMS adopted our recommendations to preserve, rather than weaken, safeguards in place for Medicare’s Six Protected Classes. On May 16, 2019, CMS announced the final drug pricing rule for Medicare Advantage (MA) and Part D plans. The draft of this rule, originally issued in November 2018, would have allowed MA and Part D plans to exclude coverage of these medications in certain situations. Aimed Alliance opposed this proposal because it could have diminished the ability of vulnerable patients, such as those with cancer, epilepsy, and HIV, to access these medications.

In the final rule, CMS heeded our recommendations and chose to abandon the proposed changes to the Six Protected Classes. However, CMS has chosen to finalize its proposal to allow MA plans to use step therapy for new starts of medications covered by Medicare Part B . This will allow MA plans to require patients to try and fail on a Part B medication before being able to access a prescribed Part D medication. The agency has fortunately included protections to ensure that patients can still access their medications in a timely manner, but this will create a new obstacle for some patients.

To review all of the changes that CMS has finalized, review their fact sheet.


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