In the latest move to lower drug prices, the Trump administration has proposed to revoke coverage of protected class drugs that treat life-threatening illnesses like cancer, HIV, epilepsy, and depression. The administration claims this will eventually lower drug prices, but patients and patient advocacy groups say otherwise, and that the move could even be deadly.
The administration’s reasoning
The goal of this proposal is simple—to drop drug prices. This has long been a priority of the Trump administration and something Trump himself has promised since his campaign days, but he has yet to succeed in this endeavor.
The logic of this proposal is that by removing the protection from these drugs, manufacturers would have to drop prices in order to compete with other drug companies. As long as Medicare plans have to cover these drugs by law, drug companies can charge whatever they want for the drugs knowing Medicare and patients will have to pay.
However, with no guarantee that protected class drugs would be covered by their plan, Medicare beneficiaries could face enormous out-of-pocket costs when they arrive at the pharmacy counter and find that their life-saving drugs are no longer covered.
Pushback
Patients and patient advocacy groups alike are staunchly proposed to this measure, even going as far as to say it could cause the deaths of hundreds of thousands of people whose lives depend on these drugs. Nine organizations have warned of the dangers of this proposal, including the Alliance for Aging Research, HealthyWomen, and the National Association of Nutrition and Aging Services Program.
Carl E. Schmid II, deputy executive director of the AIDS Institute said, “The Trump administration’s proposal is bad medicine and dangerous to people living with HIV…there is no reason to take these draconian measures.”
The Obama administration made a similar proposal in 2014, but pulled back due to outcry from patient advocacy groups and Congress.
Government barrier between patients and doctors
This move could also create a barrier between patients and doctors, forcing doctors to prescribe a drug that may not work as well solely because it’s covered and preferred drugs are not. This is a similar move to the step therapy protocol previously proposed by the administration and included in this new proposal as well. Step therapy is when a drug plan will only cover the cheapest drug available and only allow you to move up the ladder of more expensive drugs until you find one that works.
Responses from CMS and HHS
Seema Verma, Administrator for the Centers for Medicare and Medicaid Services (CMS), said if seniors do not like the new restrictions on their drug plans, they can choose another plan.
“Ultimately,” she said, “the changes we are proposing would reduce costs for protected class medicine and therefore expand access to these important medicines.”
Secretary of Health and Human Services (HHS) Alex Azar said, “President Trump is following through on his promise to bring tougher negotiation to Medicare and bring down drug costs for patients, without restricting patients access or choice.”
Protected class drugs
Coverage of protected class drugs began in 2006 under George W. Bush, three years after Medicare Part D was created to give seniors coverage of prescription medications. By law, Medicare is required to cover “all or substantially all drugs” in these six categories.
The protected class drugs and some of the ailments they treat include:
- Anticonvulsants (epilepsy, bipolar disorder, migraine prevention)
- Antidepressants (depression, anxiety, ADHD)
- Antineoplastics (cancer)
- Antipsychotics (schizophrenia, bipolar disorder, dementia)
- Antiretrovirals (HIV)
- Immunosuppressants (lupus, rheumatoid arthritis, multiple sclerosis)
Costs
In 2015, 20 percent of Medicare’s total drug spending was dedicated to protected class drugs. If passed, this proposal could save Medicare an estimated $12 billion to $15 billion over a decade.
