ASCO, along with over 50 other organizations, signed a letter from the American Cancer Society Cancer Action Network to the Department of Health and Human Services (HHS) urging the agency to reject proposed changes to Medicare Part D that could harm patient access to essential therapies, including cancer care. Specifically, provisions in the proposal target patient protections under six protected drug classes: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants.
The current proposal would allow Part D plans to impose further prior authorization requirements on drugs within the six protected classes. Such requirements include step therapy, in which a health plan requires a patient to try and fail on a lower cost or generic drug before it will cover the drug the doctor originally prescribed. This type of “fail first” therapy can unnecessarily impede patient access to needed cancer care and can lead to irreversible disease progression and other significant health risks.
Another proposed change would allow Part D plans to exclude new formulations of some protected class treatments if the new formulation has the same active ingredient and does not provide a unique route of administration vs an older version of the drug. The letter to HHS expresses grave concerns that this change would hinder beneficiary access to the latest “medical breakthrough products.”
Furthermore, Part D plans could exclude any single-source drug or biologic within the protected classes from their formularies if the price of the drug increases beyond the rate of inflation. Such a change could harm patients with cancer who need the right treatment at the right time.
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