16 July 2019 - In recent years, the Centers for Medicare & Medicaid Services has considered allowing greater flexibility in excluding coverage by Medicare Part D for drugs in 6 currently “protected” classes: anti-neoplastics, anti-retrovirals, anti-depressants, anti-psychotics, anti-convulsants, and immunosuppressants for transplant patients. 

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.

The most recent proposed rule change, issued by the CMS in November 2018, would have permitted brand-name protected-class drugs to be excluded from Medicare Part D plan formularies if list price increases in the previous 3 years outpaced inflation.

Read JAMA article