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CMS Rejects Proposed Change to ‘Six Protected Classes’ Medicare Drug Coverage

Change Could Have Risked Cancer Patients’ Timely Access to Prescription Drugs

March 17, 2021

Washington, D.C.—The Centers for Medicare and Medicaid Services (CMS) announced this week that it will not proceed with additional flexibilities to a Part D Payment Modernization Model that would have allowed participating Medicare Part D plans to limit coverage of drugs within the “six protected drug classes.” The additional flexibilities—proposed under the prior administration—would have allowed plans to treat drugs within the six protected classes as any other Part D drugs; meaning Part D plans could choose to no longer cover or substantially restrict all drugs within these classes. These changes could have delayed cancer patients’ timely access to therapies.

By halting the change, Medicare Part D plan sponsors participating in the Part D Payment Modernization Model will continue to be required to cover all or substantially all drug therapies in the designated six protected classes, including oncology drugs, once they are approved by the FDA.

A statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN) follows:

“We’re thrilled that patient voices and concerns were heard and that this proposed change will not move forward. Ensuring cancer patients have access to the latest, most innovative, and often times the only treatment for their type of cancer, is essential. Delayed access to prescription medicines can have dramatic consequences for cancer patients, which is why the cancer therapies were included among these protected classes to begin with.

“Halting this proposed change was the right thing for patients as this action will preserve critical patient access to innovative treatments.”

 

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