Medicare Rights Applauds Congressional Work to Expand Medicare Access, Urges Changes to Align Legislation With Those Goals

Late last month, the U.S. House Committee on Ways and Means advanced several bipartisan bills intended to reduce Medicare coverage and affordability barriers. While Medicare Rights applauds this important goal, we are concerned that several of the bills run counter to it. As outlined below, today we urged lawmakers to correct those misalignments.

The Ensuring Patient Access to Critical Breakthrough Products Act of 2023 (H.R. 1691) — This legislation would allow FDA-designated medical breakthrough devices to be temporarily covered under Medicare. But in so doing, H.R. 1691 would override Medicare’s ability to determine what services are “reasonable and necessary” for beneficiaries. This is an important patient safety and consumer protection in general, and in particular with respect to breakthrough technologies. These devices, by their nature, lack complete evidence of efficacy, safety, or clinical benefit for use among the Medicare population.Medicare Rights urges lawmakers to adhere to the existing reasonable and necessary safeguard; departing from this standard would undermine CMS’s ability to advance evidence-based coverage policies and put beneficiaries at significant risk.

Treat and Reduce Obesity Act of 2023 (H.R. 4818) — H.R. 4818 would allow Medicare Part D to cover certain weight-loss medications, but only for enrollees whose health insurance continuously covered the drug for the one-year period immediately prior to their Part D enrollment. It is our understanding this limitation was added to lower the cost of the bill. We appreciate the Committee’s recognition that high prescription drug prices can make medications prohibitively expensive for consumers and insurers, and that increased Part D costs program-wide could increase taxpayer burden. However, we urge solutions that address the root of that problem—the prices themselves—rather than creating a tiered system that restricts access to earned Medicare benefits and erodes the program’s promise of equitable coverage for all enrollees.

It is also concerning that this approach would cede important decisions about coverage criteria to entities providing a beneficiary’s pre-Medicare health insurance, such as private plans, self-insured employers, and state or foreign governments. These payers would not necessarily have consistent criteria or easily transferrable records, further increasing unequal treatment, administrative burden, and potential confusion.

Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act (H.R. 2407) — H.R. 2407 would allow Medicare to cover emerging blood-based cancer screenings that are FDA-approved and shown to have clinical benefit. We appreciate that unlike H.R. 1691, this bill would maintain Medicare’s “reasonable and necessary” authority. However, like H.R. 4818, this coverage would only reach some Medicare beneficiaries: those who either attain a certain age by January 1 of the relevant year or received a test in the prior 11 months. Such a carve-out would exclude millions of older adults and people with disabilities of all ages, setting a dangerous precedent and leaving many behind arbitrarily. We support the removal of this harmful provision.

Medicare Rights appreciates the Committee’s consideration of these requests, and their ongoing focus on modernizing Medicare benefits and access. We look forward to working together to advance our shared priorities in ways that strengthen the program for all beneficiaries.

Read the letter.