HHS Hears Cancer Patients’ Concerns About Timely Access to Drug Therapies in Medicare Part D

Final Rule Lessens Potential Impact

May 16, 2019

WASHINGTON, D.C.—Today the Department of Health and Human Services (HHS) issued its final rule for Medicare Part D which does not include the full range of proposed changes to drugs in the ‘six protected classes’ of cancer, epilepsy, HIV/AIDS, mental illness and organ transplants. HHS had proposed allowing plans to use additional utilization management, like prior authorization and step therapy, for all drugs in these classes, however the final rule would not interfere with already established medication regiments for cancer patients.

In addition, the proposal that would have allowed insurers to exclude new therapies that exceeded a specific price was also omitted.

A statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network follows:

“Current cancer patients will be relieved to hear their access to innovative new drug therapies will not be in question under this finalized rule. Cancer care often requires specialized treatment targeted at a patient’s specific tumor and these treatments are rarely interchangeable.

“Additionally, coverage of new drugs will not be excluded based on a pre-determined price alone. Concern remains, however, over how this may affect patients starting new therapies.

“Cancer care is a race against time. We are glad HHS and Secretary Azar listened to the countless patients who voiced their serious concern over the proposed rule. We will closely monitor implementation of this rule working to make sure all cancer patients have timely access to the therapies best suited to treat their disease.”

Media Contacts

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