The Fight to Protect Your Prescription Drug Programs
Every day, tens-of-thousands of organ transplant recipients rely upon their Medicare drug benefit. For us, immunosuppressants are necessary to help prevent rejection of the organ transplant and avoid other medical complications.
Because patients with organ transplants react differently to different immunosuppressants, access to the full range of effective medications is a crucial component of successful treatment and recovery. Fortunately, Medicare's "Six Protected Class" policy has long stood as a guarantee to patients that their access to all available medications would never be in doubt.
During implementation of the Medicare Modernization Act (MMA), which created the Medicare Part D drug program in 2003, CMS (at the urging of Congress) issued guidance directing Medicare drug plans to cover "
all or substantially all
" medications for patients with organ transplants, mental illness, epilepsy, Parkinson's Disease, lupus, cancer, and HIV.
CMS created this policy to safeguard access to lifesaving medications for vulnerable Medicare beneficiaries who rely on these classes of prescription drugs to protect them from potential medical challenges associated with any interruption or change of therapy. This means that a Medicare beneficiary on innunosuppresants, for example, can expect to get the exact treatment his or her doctor prescribes when going to the pharmacy - without having to worry about whether or not it's covered by a prescription drug plan.
Over the years, there have been challenges to this policy from various advisory groups and others who believe that this unencumbered access substantially increases the costs to the Part D system. Time after time, these challenges have been refuted by independent studies. Not only is there very little, if any, increase to Part D prescription drug costs, it is anticipated that there would be substantially more costs incurred by the patient in lab tests, doctor visits, hospitalizations, and in the case of transplant recipients, the threat of organ rejection.
For a number of years, a tireless association of patient advocacy groups that represent the six protected classes, as well as a leading Washington group of professionals, have fought to keep this policy in effect.
The association is called The Partnership for Part D Access (
). Together, this leading coalition of patient advocacy organizations has arranged meetings in Washington D. C. with congressional leaders and encouraged them to make sure CMS knows that any changes to the six protected class policy are not welcome.
Unfortunately,the voices for change continue to make noise. Under the guise of reducing prescription drug costs, there are ongoing efforts in the legislative and executive branches to substantially weaken the protected classes.
The Partnership continues to create effective strategies to counteract these voices. Visits to Congressional staffers and Members of Congress, letters to CMS and HHS officials, and effective and important public relations and social media campaigns have kept the efforts in front of the public. Grassroots efforts with letter-writing campaigns from patients have also played a major role in making sure that key members of Congress keep the pressure on CMS to abandon proposed changes to the policy.
From TRIO's point of view, Rodger Goodacre and Ike Copperman, from our sister group, Transplant Support Organization, located in Westchester County, New York, continue to keep us informed about the activities needed to maintain these protections for transplant recipients. Both Rodger and Ike have been involved in the congressional visits, the letter-writing, and the conference calls arranged by The Partnership.
|TRIO's Public Policy chair:
For May, 2019, The Partnership is mounting a series of congressional visits to legislators when they return to their home offices. Please contact Rodger (
) or Ike Copperman (
) for more details on participating in this campaign to visit legislators.