The three classes of drugs — widely used antidepressants, antipsychotics and drugs that suppress the immune system to prevent the rejection of a transplanted organ — have enjoyed special “protected” status since the launch of the Medicare prescription benefit in 2006.
That has meant that the private insurance plans that deliver prescription benefits to seniors and disabled beneficiaries must cover “all or substantially all” medications in the class, allowing the broadest possible access. The plans can charge more for costlier drugs, but they can’t just close their lists of approved drugs, or formularies, to protected medications.
In a proposal published Friday in the Federal Register, the administration called for removing protected status from antidepressants, antipsychotics, and immunosuppressant drugs. The proposal said that status it is no longer needed to guarantee access, would save millions of dollars for taxpayers and beneficiaries alike, and could help deal with the problem of improperly prescribed antipsychotics drugs in nursing homes.
Quote: Proposed changes to the Medicare drug benefit