Proposed Changes for Protected Class Drugs for Medicare Part D

At the end of 2018, the Administration proposed changes to the protected class drugs for Medicare Part D, including all antidepressant and antipsychotic drugs. Part D Protected class drugs ensure that once you are on a medication and stable, your insurance plan could not change your prescription on your current plan or even subsequent plans, and off-label uses must be covered in the protected class. In addition to being important for our patients on Medicare, it is important to note that Medicare policy can often influence Medicaid policies and private insurance policies.

The Administration, under the auspices of cost-cutting, proposed the ability for plans to switch drugs at any time, even if a patient was stable. Also, the plans would not be required to cover off-label uses. Both of these proposed changes would have negatively impacted the Tourette Syndrome community. The Tourette Association Impact Survey clearly showed that many of in the community have had to try multiple medications to find the right one, but could be switched off of the right prescription. Plus, off-label medications are often prescribed when the three drugs approved are not well tolerated or contraindicated. Consequently, the Tourette Association of America (TAA) had made this proposed change a top public policy priority issue.

The Tourette Association submitted comments to the Administration and held dozens of meetings with Congressional staff opposing these changes. The TAA also participated with the MAPrX Coalition and the Partnership to Protect Part D to work with other patient groups who also utilize protected class drugs for congressional meetings and comments and addressed the changes during our 2019 Advocacy Day last march .

As a result, we are pleased to report that the Administration recently released their Medicare Part D Final Rule and the proposed changes were not included. This is in part thanks to the hard work of those who met with representatives on Advocacy Day last March to advocate on behalf of the TS and Tic Disorder community, as well as our MAB/SAB Advocacy Work Group for their expertise and input on our comments. Their impact shows we can accomplish amazing things when we all work together to amplify priority policy issues and must continue to do so by contacting Congressional leaders.

Diana Felner
Vice President, Public Policy
Tourette Association of America