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BIO Statement on Proposed Changes to Medicare Advantage and Part D Plans

“Today’s proposed rule to roll back critical protections afforded to some of America’s sickest and most vulnerable Medicare beneficiaries would, if adopted, severely limit seniors’ access to the drugs most appropriate for them, and is yet another unfortunate example of Administration proposals that will financially benefit insurance plans and other middlemen in the drug supply chain at the expense of patients."

BIO Statement on Proposed Changes to
Medicare Advantage and Part D Plans

Washington, DC (November 26, 2018) – BIO President and CEO Jim Greenwood issued the following statement regarding today’s proposed changes to Medicare Part D and Medicare Advantage plans:

“Today’s proposed rule to roll back critical protections afforded to some of America’s sickest and most vulnerable Medicare beneficiaries would, if adopted, severely limit seniors’ access to the drugs most appropriate for them, and is yet another unfortunate example of Administration proposals that will financially benefit insurance plans and other middlemen in the drug supply chain at the expense of patients.

“To protect Medicare beneficiaries receiving treatments for certain conditions such as cancer, HIV/AIDS, schizophrenia, and organ transplantations, Congress created in 2008 statutory rules that require Medicare to cover “all or substantially all” drugs available within these specific therapeutic classes. Because of the risks, complications and added expense which can arise with interruptions in treatment for these vulnerable populations, it is vital that these patients and their physicians can choose therapies based upon each patient’s individual clinical circumstances, rather than the decisions of insurance company bureaucrats.

“While we plan to review today’s proposal in detail and offer our detailed comments in due course, it appears that the proposal would seriously undermine these statutory protections for medically vulnerable seniors.  We hope that the Administration will put patients ahead of insurance companies and maintain the important beneficiary protections in Part D that Congress intended for the program.

“That said, we are encouraged that the Administration plans to take steps to implement important patient safeguards, including aligning the appeals process in Medicare Part B with those in Part D and requiring Pharmacy and Therapeutics (P&T) Committee review of step therapy policies. BIO has called on the Administration to make these and other changes in order to enhance patient protections against ill-considered insurance company coverage determinations.

“BIO will continue to work with the Administration to help shape final rules in these areas.”