CMS Reverses Proposed Change That Would Have Weakened Part D Protections

The Centers for Medicare & Medicaid Services (CMS), the agency that runs the Medicare program, recently reversed a change to Part D demonstration rules announced by the previous administration that would have allowed participating plans to eliminate important beneficiary protections. The Medicare Rights Center and our partners spoke out strongly against the proposed change and encouraged the Biden administration to uphold these protections.

The demonstration, known as the Part D Payment Modernization Model, is intended to test Part D changes to see if they will change drug spending. The proposal would have allowed plans that participate in the demonstration to reduce the number of medications they cover, including in the “protected classes.” These are groups of medications, like antipsychotics, antidepressants, and antiretrovirals, for which the individual and public health consequences of disruption or interruption of care are so significant that plans are required to cover substantially all of the drugs in that group. The proposal would also have halved the number of medications plans are required to cover in all other groups – from two to one. 

While it is clear that drug prices are too high, limiting beneficiaries’ access to needed, life-saving medications cannot be the method used to bring prices down. Medicare Rights commends CMS for responding to stakeholder concerns and deciding not to go forward with these unadvised and dangerous policy changes.

Read the partnership letter.

Read more about the demonstration models.