Medicare Rights Center President Joe Baker Testifies in Congress on Rule Proposing Changes to Medicare Advantage and Part D
— Evaluates individual policies, supporting many and opposing some —

Washington, DC – Joe Baker, President of the Medicare Rights Center, testifies today before the Subcommittee on Health of the U.S. House Committee on Energy and Commerce regarding recent changes to the Medicare Advantage and the Part D prescription drug program proposed by the Centers for Medicare & Medicaid Services (CMS).

In his testimony, Baker recognizes the strides that CMS seeks to make in the areas of oversight, monitoring and transparency. He also emphasizes that each of the proposed policies reflected in the rule should be evaluated on their own merits—as opposed to supporting or opposing the proposed rule as a whole.

“We believe the evaluation of this rule should not be a zero-sum game,” says Baker. “Many of the rule’s provisions will benefit people with Medicare and should be implemented as proposed. We support other provisions with suggested changes and there are others we oppose altogether.”

The provisions of the rule that the Medicare Rights Center supports include those that would:

• Ensure meaningful differences between Part D plans
• Increase drug pricing transparency, fairness, and accuracy
• Enhance Medicare Advantage and Part D plan oversight
• Improve beneficiary notices detailing  plan changes

“We strongly support CMS’ desire to ensure meaningful differences among Part D plans by further consolidating plan options,” says Baker. “On our national helpline, we observe that older adults and people with disabilities find choosing among a large number of Part D plans to be a dizzying experience. Most people with Medicare fail to reevaluate their coverage options on an annual basis, largely because there are too many options and too many variables to compare, even when they can save money or increase their coverage by switching plans.”

Baker’s testimony also expresses opposition to CMS’ proposed policy to scale back the protected drug classes in Medicare Part D, which would end open formulary access for the antidepressant, antipsychotic and immunosuppressant drug classes. The testimony asserts that CMS’ reliance on existing beneficiary protections, including the Part D appeals process, to preserve access to drugs that lose protected status is misplaced.

“Based on our experience counseling Medicare beneficiaries, we believe the protections that CMS refers to are insufficient—especially the Part D appeals process,” says Baker. “According to CMS, over half of plan-level denials are overturned after they are independently reviewed. This alarming rate of reversals raises serious questions about how well the appeals process can be counted upon to protect beneficiaries. More importantly, the appeals process must be streamlined so that people who are denied drugs can get a denial notice from their plan at the pharmacy counter. A person who needs access to a prescription should not be forced to leave the pharmacy counter without the prescription, without any idea of why they were denied the drug, and only a piece of paper telling them what number or website they can call to receive an ‘actual’ denial to start an appeal.”

CMS also points to drug prices as a primary reason for scaling back the protected drug classes. Baker recognizes that these concerns are valid, but that CMS should not pursue policies that unduly restrict access in order to address the problem.

Baker concludes his testimony by saying, “To address concerns regarding drug pricing in Medicare, Congress should restore previously proposed Medicare drug rebates for beneficiaries dually eligible for both Medicare and Medicaid, which would save taxpayers over $140 billion over 10 years.  These significant savings could be achieved without increasing beneficiary costs or restricting access.”

Read the testimony.

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