Patient Advocates Commend CMS for Maintaining Medicare’s Six Protected Classes Policy

Published on June 4, 2019

As designed by Congress, Medicare’s six protected classes policy guarantees access to treatments for Medicare patients with the most complex conditions, including cancer, HIV/AIDS, mental health conditions, epilepsy, organ transplants, and Parkinson’s


Washington D.C. — The Partnership for Part D Access, a broad-based coalition of health care stakeholders including over 20 diverse patient advocacy organizations, commended the Centers for Medicare and Medicaid Services (CMS) for not finalizing a proposal that would have substantially weakened Medicare’s six protected classes policy.

Medicines in the six protected classes treat serious health conditions, and among these vulnerable beneficiaries — the frail, disabled or those with multiple chronic conditions — many medicines are not interchangeable. Seemingly similar patients often respond differently to the same drug: while one patient will respond well, a similar patient will have a suboptimal response, or worse. Further, drugs in the same class often have different side effects, and patients are often better suited to one particular drug over another.

“Medicare beneficiaries with the most complex, chronic conditions are breathing a sigh of relief,” said Chuck Ingoglia, Sr. Vice President of Public Policy and Practice Improvement at the National Council for Behavioral Health, who serves as Executive Director of the Partnership for Part D Access. “This rule cements Medicare’s protected classes policy as an essential patient safeguard in Medicare’s prescription drug program.”

Today’s decision was bolstered by the support of over 120 Members of Congress, including key leaders on health care committees of jurisdiction:

  • At a recent hearing of the Energy & Commerce Committee, four key members of the committee raised concerns with the proposal — including Ranking Member Greg Walden (R-OR) and Health Subcommittee Chair Anna Eshoo (D-CA);
  • Nineteen Energy & Commerce and Ways & Means Committee Democrats sent a letter to HHS;
  • Fourteen bipartisan Senators sent a letter to CMS;
  • Seventy-three House Members sent a letter to HHS; and
  • Thirty-nine members of the Congressional Mental Health Caucus sent a letter to HHS.

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