by – Sheri de Grom
The Obama Administration (the Centers for Medicare and Medicaid Services) set forth a proposed rule, January 2014. The proposal [Federal Register Vol.79, No 7, Pg1-157] would have brought about broad changes for about 39 million Medicare Part D beneficiaries.
The proposed rule would have ended the practice of covering “all or substantially all” drugs within six classes: antidepressants, antipsychotics, anticonvulsants, antineoplastics and immunosuppressants. This policy, known as the “six protected class” policy, has been in effect since the inception of Part D, and has strong congressional support.
Medicare tried to sell the proposal as a way to save taxpayers money and simplify the Part D program for seniors.
The ‘administration’ has indicated they will revisit their proposed plan and will submit a new proposed rule in the future. When the proposed rule is set forth, EVERY CITIZEN has the right to comment.
You do not need to be enrolled in Medicare to comment on any proposed rule set forth. As an American citizen, you’re entitled to express your opinion on every proposed legislative change. A proposal will become law if not enough citizens can support keeping the law as stated in its current format.
The House and Senate advised Medicare to back off and in a letter drafted by Orrin Hatch (R. Utah), clearly placed on record to Medicare that congressional members (both parties) had strong objections to the Medicare Part D proposals and were concerned the changes would disrupt care and unnecessarily interfere with an already successful program.
It’s important to remember the patients qualifying for coverage by Medicare and Part D are not just those over 65 but also those that are disabled and unable to work. This proposed rule would take away the coverage of numerous drugs necessary for mental health treatment.
I’m confident we’ll see further erosion of Medicare Part D. It’s the only plan within Medicare that helps pay for pharmaceuticals and the patient pays the premium and additional co-pays.
Thankfully, Tom and I have my Federal BC/BS and his Tri-Care for Life for our pharmacy coverage. I don’t believe I’d have the sanity to cope with Part D.
David L. Shern, Ph.D, president and CEO of Mental Health America, said, “These policies fail to acknowledge that physicians and consumers should make individualized treatment decisions, recognizing the unique and non-interchangeable nature of human beings and psychotropic medications, and acknowledging that lack of access to medications has both human and fiscal consequences.”
Medicare’s prescription drug program is widely considered to be a Washington success story. However, the Obama administration is proposing a series of significant changes to fix what critics say isn’t broken.
In my opinion, the continued attempts of Medicare administrators to destroy a program that works efficiently (Medicare Part D), is further evidence that our current administration has no one appointed to a cabinet position with ‘real world’ work experience. Their job security has never been threatened by real world performance standards and customer satisfaction.
The nomination of Robert McDonald, to Secretary of Veterans Affairs, former CEO of Proctor and Gamble, is the first executive with actual public leadership ability who understands what it means to be accountable to stockholders. Taxpayers have not had accountability with other cabinet positions.
I expect to see a newly formulated proposed Medicare Part D Rule submitted within the next six months. If you see the proposal before I do, please let me know. I wish to add my comment to the Federal Register plus express my views to elected officials.
What are your thoughts? Have you had success or problems with Medicare, Plan D? There were a significant number of changes with most insurance plans in 2014. Has your insurance changed their pharmacy coverage?