CMS drops Trump administration proposal to negotiate protected class coverage

CMS will not implement a proposed change to Medicare Part D that would have allowed plans to exclude some drugs in six protected therapeutic classes from their formularies, but will allow for broader use of prior authorization and step therapy. The announcement was part of a package of final changes to the Medicare Advantage and Medicare Part D programs released Thursday.

Medicare Part D requires that plans cover all drugs in six protected indications or classes: antidepressants; antipsychotics; anticonvulsants; immunosuppressants for the treatment of transplant rejection; antiretrovirals; and cancer treatments. HHS Secretary Alex Azar and CMS proposed in November to allow plans to use formulary access as a negotiating tool, including excluding treatments when the drug is a new formulation of an existing drug or biologic (see "CMS Takes Aim at Protected Drug Classes, Allowing Step Therapy, Exclusions")...