Medicare Officials Back Away From Changes To Prescription Drug Plan
Facing heavy bipartisan opposition on Capitol Hill as well as from patient groups, businesses, insurers and others, the Centers for Medicare聽& Medicaid Services 聽it did not plan to move ahead 鈥渁t this time鈥 with several proposed changes to the Medicare prescription drug program.

The draft , which had been released in January,聽would have wide-ranging impact on the drug program, also known as Part D, including new limits on the number of plans insurers could offer consumers and new rules about what drugs those plans must cover. It also would prohibit exclusion of pharmacies from a plan鈥檚 鈥減referred pharmacy network鈥 as long as the pharmacies agreed to the plan鈥檚 terms and conditions.
During the rule鈥檚 comment period, which closed March 7, CMS received 鈥渘umerous concerns about some elements of the proposal鈥 from lawmakers and stakeholders, CMS administrator Marilyn Tavenner said in a letter to Congress.
鈥淕iven the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time,鈥 Tavenner said, adding that the agency will 鈥渆ngage in further stakeholder input before advancing some or all of these changes in these areas in future years.鈥 The agency will, however, move forward with other elements of the rule, she said,聽聽including those aimed at ensuring access for beneficiaries during natural disasters, reducing fraud and聽broadening the release of Part D data that does not identify beneficiaries.
Currently, Medicare has six protected drug categories. CMS two of those starting in 2015 with antidepressant drugs and those that help suppress the immune system. The agency also said in the draft rule that it was considering dropping protected status for antipsychotic drugs in 2016.聽Lawmakers in both parties and representatives of patient groups , saying that making those changes could stop patients from getting the drugs they need. CMS maintains that safeguards in current law will ensure that patients receive necessary medications, and point out that 140 other classes of drugs are offered through the prescription drug program, even though they are not covered by protected status.聽 CMS also says that special status hurts the prescription plans’ ability to negotiate discounts with drug makers.
Another element of the proposed rule would allow insurers to offer no more than two prescription drug plans 鈥 one basic plan and one enhanced 鈥 in the same service area.聽The health law鈥檚 ongoing closing of聽 the Part D 鈥,鈥 the gap in coverage where seniors pay the full cost of coverage before the plan鈥檚 catastrophic cap kicks in, 鈥渉as reduced the need for plans offering enhanced benefits,鈥 according to CMS. The agency says that each region of the country now has on average nearly three dozen plans and reducing that would help give beneficiaries more clarity about the differences among plans. Critics of the proposal said it would limit seniors鈥 choices for coverage.
CMS鈥 plan was attacked on several fronts. A coalition of more than 370 groups representing seniors, patients, health care providers and employers a letter to Tavenner in opposition. A bipartisan majority of the Senate Finance Committee 聽Tavenner they were 鈥減erplexed as to why [CMS] would propose to fundamentally restructure Part D by requiring immediate, large-scale changes to the program that have direct consequences for beneficiaries.鈥澛 Republicans on the House Energy and Commerce panel . And, Rep. Renee Ellmers, R-N.C., a member of the House leadership team, introduced that would stop CMS from moving forward with the rule鈥檚 prescription drug provisions. The bill is scheduled for a floor vote Tuesday.
Rep. Sander Levin of Michigan, the ranking聽Democrat on the House Ways and Means Committee, said the administration鈥檚 decision to not 鈥渇inalize the most controversial proposals in the Part D proposed regulation shows they have listened to stakeholder comments.” He suggested that Ellmers’ bill聽“would be a gross overreach.”
Some congressional Democrats, facing a tough聽 midterm election battle, were nervous that a battle on changes to the Medicare drug program could make them even more vulnerable.
Republicans have made repeal of President Barack Obama鈥檚 health care law central to their campaign to take control of the Senate and keep the House in the fall elections. The idea of eliminating some Part D plans because they are duplicative of current offerings — CMS鈥檚 rationale for the proposed change — has helped Republicans revive criticism of the president鈥檚 鈥溾 pledge on the health law.