CMS REVERSES REVERSES COURSE ON PROTECTED CLASSES

Yesterday the Centers for Medicare & Medicaid Services decided against implementing a previously proposed measure that would provide insurers with more flexibility around the coverage of certain Part D drugs.

Why this matters: The proposal dealt with protected classes of drugs. Part D plans are required to cover every drug in these 6 classes on their formularies. CMS had proposed allowing plans to exclude drugs in a protected class if the price of the drug increased a certain amount over a specified time period, or if the drug was only a new formulation of an existing drug without competition.

Notable Quotes: “Current cancer patients will be relieved to hear their access to innovative new drug therapies will not be in question under this finalized rule. Cancer care often requires specialized treatment targeted at a patient’s specific tumor and these treatments are rarely interchangeable,” Lisa Lacasse, president of the American Cancer Society Cancer Action Network