Is Medicare drug coverage in jeopardy?


Republican committee leaders are pushing the Obama administration to call off proposed changes to the Medicare prescription drug program, arguing the overhaul would jeopardize seniors’ plans and raise premiums.

The charges pertain to recent regulations proposed by the Centers for Medicare and Medicaid Services (CMS). The rules would allow the agency to participate in negotiations between insurance companies and pharmacies in Medicare Part D for the first time out of concerns over cost and access.

{mosads}Supporters of the change argue the CMS needs new authority to ensure the market for prescription drugs in Part D works for patients. But Republicans said the proposal will allow the agency to unnecessarily interfere with existing drug plans, potentially forcing millions of seniors out of their coverage.

“Despite the program’s far-reaching success, CMS is proposing to fundamentally undermine the program and jeopardize the prescription drug plans that million [sic] of seniors rely on for their health and peace of mind,” the members wrote.

“Washington should not be inserting itself between seniors and the prescription drug plans that they chose and depend on. But that is exactly what your administration’s proposed rule would do.”

The letter was written by House Energy and Commerce Committee Chairman Fred Upton (R-Mich.), House Ways and Means Committee Chairman Dave Camp (R-Mich.) and Senate Finance ranking member Orrin Hatch (R-Utah).

The wide-ranging proposed rules were published on Jan. 6 and flew under the radar amid controversy over ObamaCare’s rollout. But the 700-page regulation is now receiving attention from healthcare stakeholders concerned about its consequences.

A varied coalition of 200 organizations wrote to the CMS this week urging the agency to withdraw its proposal. The groups included the Chamber of Commerce as well as top insurers, drug companies, disease advocates and pharmacy chains.

“Each undersigned organization has concerned about specific provisions, but there are overarching issues on which we are unanimous in our objections,” the letter stated.

“The rule would significant reduce beneficiaries’ choice of plans and medicines and lead to disruptions in care. … It would fundamentally transform the market-based competitive models that have made the Part D program highly successful.”

Federal health officials counter that a revised system would save money, hold plans and providers to account and enhance consumer choice within Part D.

The regulations would also open plans’ preferred networks to a wider range of pharmacies, limit plan bids within a region and remove “protected class” designations for certain types of drugs.

The CMS hopes to finalize its proposal to take effect for the 2015 contract year, a very slim timetable for rule-making. 

Tags Medicare Medicare Prescription Drug, Improvement, and Modernization Act Orrin Hatch Pharmaceuticals policy

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