In recent years, the Centers for Medicare & Medicaid Services (CMS) has considered allowing greater flexibility in excluding coverage by Medicare Part D for drugs in 6 currently “protected” classes: antineoplastics, antiretrovirals, antidepressants, antipsychotics, anticonvulsants, and immunosuppressants for transplant patients.1 CMS and insurers have argued that the protected-class policy requiring coverage for essentially all drugs—which does not apply to commercial payers—hinders effective price negotiations by Medicare Part D plans and contributes to rising prescription drug costs.1,2
Hwang TJ, Dusetzina SB, Feng J, Maini L, Kesselheim AS. Price Increases of Protected-Class Drugs in Medicare Part D, Relative to Inflation, 2012-2017. JAMA. 2019;322(3):267–269. doi:10.1001/jama.2019.7521
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