Access to Medications Under Medicare’s 6 "Protected Classes" Policy Remains the Same

March 17, 2021

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced a proposed policy by the Center for Medicare and Medicaid Innovation (CMMI) that would have allowed health plans to reduce their coverage of drugs in Medicare’s 6 “protected classes." This policy change could have had negative consequences for patients, including those impacted by cancer. We were concerned that the proposed changes could jeopardize the ability of people with Medicare health coverage to access medications used to manage complex conditions such as cancer, mental illness, HIV-AIDS, epilepsy, Parkinson’s, and organ transplantation.

On March 16, CMS announced that it would not move forward with proposed policy changes to Medicare’s 6 “protected classes.” The Cancer Support Community (CSC) applauds this decision, as this policy change would have had negative consequences for patients, including those impacted by cancer.

This announcement is a huge victory for patients and the advocacy community.

Background on Medicare Part D and the 6 “Protected Classes”

Medicare’s Part D (prescription drug coverage) program helps people cover the costs of their prescription drugs. Part D benefits are provided through private health insurance plans that are approved by Medicare. Medicare beneficiaries can supplement their traditional Medicare by choosing between a separate prescription drug plan or a Medicare Advantage prescription drug plan.

When Congress designed the Medicare Part D program, it ensured that the full range of drugs in the “six classes” would be guaranteed on all health plans for the patients who need them, and protections were created to prevent discriminatory practices intended to limit and/or discourage the use of these drugs. The 6 classes of drugs are:

  • Antidepressants (used to treat depression)
  • Antipsychotics (used to manage psychosis)
  • Anticonvulsants (used to treat seizures)
  • Immunosuppressants (antirejection medications for those receiving organ transplants)
  • Antiretrovirals (used to manage HIV/AIDS)
  • Antineoplastics (used in chemotherapy to kill cancer cells)

The Need to Support Medicare's Essential Patient Protections

People with Medicare health coverage who have cancer need access to all of the medications that will not only treat their cancer but meet their mental health needs and other comorbidities. Individuals diagnosed with cancer are at risk of experiencing depression after diagnosis, which can negatively impact their outcome and the costs of care. A recent CSC study found that:

  1. 34% of participants were identified as at risk for clinically significant depression
  2. 43% of participants were identified as at risk for clinically significant anxiety
  3. 29% were identified as at risk for both clinically significant depression and anxiety

This data show why the protected classes policy is vital. CSC will continue to make sure patients have access to all of the medications that their physician recommends to treat their specific health needs.