Cancer Patients in Medicare Could Face Cost and Care Barriers Under Proposal to Alter ‘Six Protected Classes’

Drug Pricing Policy Should Prioritize Patient Affordability

November 26, 2018

WASHINGTON –  The Department of Health and Human Services announced proposed changes to the Medicare Part C and D regulations today that if finalized could dramatically impact access to affordable medication and quality care for cancer patients on the program. The administration is proposing to alter rules around Medicare Part D’s “Six Protected Classes.” The proposals could have cost, care and safety implications.

A statement from American Cancer Society Cancer Action Network (ACS CAN) President Chris Hansen follows:

“While we support the administration’s intent to improve drug affordability, the proposed changes could have life or death consequences for cancer patients on Medicare. Age is the single greatest risk factor for cancer - disproportionately affecting the population receiving health coverage through the program. Half of the 1.7 million new cancer cases diagnosed in the U.S. this year are projected to be among people 65 or older.

“The proposals aim to save the Medicare program money, but in their current form could actually have the inverse effect, raising costs in other parts of the program and likely resulting in tremendous cost-shifting to patients. Proposed changes to the ‘Six Protected Classes’ – including excluding drugs from formularies – as well as allowing greater use of prior authorization and step therapy could hinder many beneficiaries' access to their medication. If beneficiaries are unable to access the prescription drugs most medically appropriate for their condition, they will likely incur higher costs such as additional physician services or emergency room utilization.

“The ‘Six Protected Classes’ were established so Medicare beneficiaries reliant upon these drugs would not be discouraged from enrolling in certain Part D plans, and to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations. Altering those categories would be tantamount to backdoor discrimination, where plans could be designed to exclude treatment for certain conditions.

“Advances in cancer treatment have resulted in many therapies that are designed to target very specific conditions and oftentimes have no therapeutic equivalent. Allowing plans to cover just one drug per class or subclass could result in the exclusion of many unique cancer therapies, leaving patients unable to find a plan that will cover the only potentially lifesaving drug to treat their condition.

“ACS CAN is committed to working with the administration on behalf of cancer patients and survivors to advance proposals that will reduce out-of-pocket costs for Medicare beneficiaries and maintain access to quality care. We are concerned that these proposals don’t accomplish either of those goals. Drug therapies are a critical part of cancer treatment and ensuring Medicare beneficiaries have uninterrupted access to recommended care is critical.”

Media Contacts

Allison Miller
Director, Media Advocacy
Washington, D.C.
Alissa Crispino
Vice President, Media and Advocacy Communications
Washington, D.C.