Health and Human Services (HHS) is proposing drastic changes to the Medicare Part D program’s six protected classes of medications. Under the current framework, Part D plans are required to cover “all or almost all” drugs in these six classes, including antidepressants and antipsychotics. The administration’s proposed changes would disrupt these patient protections, potentially jeopardizing the current mental health treatment regimens of Medicare beneficiaries.
Among the changes proposed by HHS, are restrictions tied to arbitrary measures and new drug classifications, potentially denying patients new, innovative medications. Additionally, the administration is seeking to impose step therapy or “fail first” constraints on treatments under six protected classes, mandating some patients try other, potentially less effective medications before they have access to a more tailored regimen fit for their individual needs. These changes could apply to current treatment plans, which could cause patients with mental health needs to lose access to medications that are working.