CMS finalizes ASCP Recommendation to Uphold Six Protected Classes Policy
Tuesday, May 21, 2019
Alexandria, V.A. - The American Society of Consultant Pharmacists (ASCP) commends the Centers for Medicare and Medicaid Services (CMS) for not finalizing a proposal that would have substantially weakened Medicare's Six Protected Classes policy.
ASCP, in collaboration with the Partnership for Part D Access, a broad-based coalition of health care stakeholders including over 20 diverse patient advocacy organizations, has spent the last five months engaging with lawmakers on and off Capitol Hill in support of maintaining the current Six Protected Classes policy. Our efforts inspired much opposition to this proposed rule, including:
- Advocating for 73 House Members to send a letter to HHS
- Encouraging 19 Energy & Commerce and Ways & Means Committee Democrats to send a letter to HHS
- Working with 14 bipartisan Senators to send a letter to CMS in support of the Six Protected Classes; and
- ASCP CEO and Executive Director, Chad Worz, sat on multiple congressional briefings educating lawmakers on the importance of the Six Protected Classes policy
The Six Protected Classes policy guarantees that Medicare patients can get the treatment they need. As pharmacists, we recognize that the least expensive medication may not always be the best medication for the patient. Unwanted side effects leading to noncompliance, medication mismanagement, and hospitalizations often results in patient harm as well as costs to the health care system. Weakening the protection for these classes would have prevented Medicare beneficiaries from accessing the full range of treatment options, regardless of their medical history or provider's best judgement.
While ASCP supports the Administration's decision to not remove the Six Protected Classes policy, our pharmacists are disappointed that the final rule fails to reform pharmacy direct and indirect remuneration fees (DIR).
Our organization supports efforts to lower drug costs and increase transparency. The current regulatory loophole that DIR fees operate under exploits beneficiaries and increases costs to seniors and the government. DIR fees are misused by payers to claw back reimbursement from pharmacies for the prescription drugs that they provide to Medicare beneficiaries.
Currently, Pharmacy Benefit Managers (PBM) and Prescription Drug Plans (PDP) are able to take reimbursement from pharmacies and patients months after the prescription has been dispensed due to the loose terminology used in the Medicare program related to pharmacy reimbursement and drug pricing. This scheme ultimately leads to higher out-of-pocket drug costs for patients and increased costs for the government. By not finalizing the proposed changes to DIR fees, CMS has failed to increase transparency of the drug pricing chain, to the detriment of older adults throughout the country.