— The Obama
administration's top Medicare official on Tuesday defended proposed
changes to the popular Part D drug benefits program for the elderly
and disabled that are fiercely opposed by a broad network of
drugmakers, insurers, healthcare providers and patient advocates.
The Centers for Medicare and Medicaid Services (CMS)
proposed a new rule in January that would fundamentally alter the
program's private insurance coverage for certain drugs, change the
pharmacy networks that some plans cover and limit the number of
policies available to beneficiaries in any given region.
That has stirred concern about the potential for turmoil that
critics fear could leave some beneficiaries without coverage for the
drugs they need and with fewer choices overall.
But Medicare chief Jonathan Blum said in written testimony to a
congressional panel that the 2015 policy changes are needed to head
off higher costs to the program from expensive new biologic
therapies and rising subsidies for insurers and lower-income
"In order for Part D to remain successful, we have to celebrate its
successes and address its vulnerabilities," Blum told the House
Energy and Commerce Health Subcommittee in remarks for a Wednesday
hearing at which he is slated to testify.
CMS, which is part of the U.S. Department of Health and Human
Services, is under mounting pressure to withdraw the proposed rule.
More than 200 companies and groups called for the rule's withdrawal
"in the strongest terms" last week, saying in a letter to CMS
Administrator Marilyn Tavenner that the changes were unnecessary for
a program that has proved effective and popular up to now.
The proposals have also become fodder for this year's congressional
election campaign, with Republicans warning that the changes would
jeopardize the entire Part D program. Some Democrats have also
Part D, a $70 billion program launched a decade ago under former
President George W. Bush, provides private insurance for
prescription drugs to nearly 40 million elderly and disabled
Medicare beneficiaries. Over 10 years, its costs of $346 billion
have been 45 percent lower than initially projected.
Ninety-five percent of Part D beneficiaries say they are satisfied
with the program, and government officials note that it has saved
$8.9 billion on prescription drug costs for Medicare recipients.
One of the proposed rule's most controversial provisions would
remove a requirement that insurers cover all drugs in two classes:
antidepressants and immunosuppressants used in transplants. Three
other protected classes would remain: antineoplastics used in
chemotherapy, anticonvulsants for epilepsy and bipolar disorder and
antiretrovirals used in the treatment of HIV.
Another class, antipsychotics, would remain protected at least
through 2015 while CMS evaluated the need to retain its status.
In his testimony, Blum assured lawmakers that beneficiaries would
still have access to the drugs they need and that there would be
adequate notification for patients before a drug could be removed
from a plan's coverage.
He suggested the change would lead to greater competition and
"Once the requirement to cover all drugs in a class was removed, we
would expect manufactures to negotiate for their products to remain
on many (insurance plans) in order to retain as much market share as
possible," Blum said.
A proposal to widen the preferred pharmacy networks that plans offer
beneficiaries in exchange for lower co-payments would also improve
market driven competition, he said.
"A few sponsors have actually offered little or no savings on
aggregate drug prices in their preferred pharmacy pricing,
particularly in mail order claims for generic drugs," he said.
Blum said a proposal to limit the number of Part D plans in any
given region to two would help clarify the choice of plans available
by presenting beneficiaries with "meaningfully different benefits
and transparent costs."
(Reporting by David Morgan; Editing by