CMS takes aim at protected drug classes, allowing step therapy, exclusions

Just as the Obama administration before it, HHS Secretary Alex Azar and the Centers for Medicare & Medicaid Services unveiled a proposed rule change on Monday that would target drugs in protected therapeutic classes, allowing plans to exclude drugs with large price increases or new formulations of an existing therapy.

Currently, Medicare Part D requires that plans cover all drugs in six different indications or classes: antidepressants; antipsychotics; anticonvulsants; immunosuppressants for the treatment of transplant rejection; antiretrovirals; and cancer treatments. The designation of these protected classes has long been thought to be a drain on CMS spending because plans have little to no power to negotiate a lower price...