CMS drops plan to erode Medicare Part D protections, retains generic, biosimilar incentives

Citing “stakeholder feedback and other considerations,” CMS has jettisoned a Trump administration plan that would have allowed Medicare Part D plans to avoid covering drugs in protected therapeutic classes starting in 2022.

The initial version of the Part D Payment Modernization Model, announced on the penultimate day of the Trump administration, would have allowed plans to exclude coverage of some FDA-approved treatments in five of the six protected classes: anticonvulsants, immunosuppressants, antidepressants, antipsychotics, and cancer. It would have maintained protections for antiretrovirals. Patient advocacy groups and the biopharmaceutical industry strongly opposed lifting protected class requirements. ...