ST. PAUL, Minn. – From coast to coast, people who rely on Medicare Part D could be left without their medications if a proposal by the Centers for Medicare and Medicaid Services is adopted.
Medicare Part D is a federal program that subsidizes prescription drug costs for 45 million seniors and people with disabilities.
The feds say they want to amend what's called the "six protected classes rule," and allow insurers to exclude many drugs from Part D plans.
Fatima Hyacinthe, trainer and engagement director with the Black AIDS Institute, says people who rely on those medications already report discriminatory practices by insurance companies, despite the rules. "Situations where people who were in treatment for substance use disorder, and as soon as they were seen to not need that kind of intensive treatment – which is often the best practice for treatment – their insurance stops covering it," says Hyacinthe.
The CMS says the change would save money, but opponents warn that short-term savings could be canceled out by more spending on emergency-room visits. This month, a California judge ruled against Minnesota's UnitedHealth Group, after determining the insurer discriminated against patients with mental health and substance abuse disorders in order to save money.
The proposal was made late last year but has not yet taken effect. Consumer advocates say removing drug-price protections from people with a serious illness could make a dire situation worse. Hyacinthe sees the Medicaid Part D proposal as part of a broader attack on equality in health care. "One day, we're de-funding Medicare Part D or taking the teeth out of it," says Hyacinthe. “Another day we're creating work requirements for Medicaid recipients. And these things target the same group of folks – again and again, and again."
The Trump administration's proposal also would allow insurers to require that a patient try cheaper and potentially less effective medications first – and only grant access to newer, more effective prescriptions if the cheaper medications don't work.
