CMS Drops Proposal to Restrict Access to Immunosuppressive Drugs

Nikia Okoye  |  Posted
Pills spilling out of container

There was wonderful news for transplant patients today: the Centers for Medicare and Medicaid Services (CMS) dropped a proposal that would have restricted access to immunosuppressive drugs under Medicare Part D.

This decision came about after the nation’s patient advocacy organizations alerted CMS and members of Congress to the negative impact such a policy change would have on transplant patients’ health.

At the American Kidney Fund, we are particularly grateful to more than 700 members of our Advocacy Network who visited our website over the past couple of weeks to send messages on this issue to their Congressional representatives. We also thank the members of our Advocacy Network who highlighted this issue in meetings with Congressional offices last week during AKF’s Kidney Action Day on Capitol Hill.

Immunosuppressive drugs are one of six “protected classes” of drugs under Medicare Part D. This means that Medicare Part D must cover all approved immunosuppressive drugs, giving transplant recipients access to the full range of available medications. In January, CMS proposed a change to Medicare Part D that would have revised the criteria for these protected classes of drugs—Part D plans would no longer be required to cover all approved immunosuppressive medications. Instead, Part D plans would only be required to cover up to two drugs within each subclass of immunosuppressive medications.

Patient advocacy organizations let CMS know that by not covering all of the specific drugs within each subclass, this rule would put patients’ health at risk. Transplant patients require access to the full range of approved medications; physicians prescribe these drugs in combinations that are carefully tailored to meet the needs of individual patients.

CMS listened. In a letter today to Congressman Henry Waxman, Ranking Member of the House Energy and Commerce Committee, CMS Administrator Marilyn Tavenner said the agency “received numerous concerns about some elements of the proposal from members of Congress and stakeholders.”

While we celebrate this victory, we know that our work on this issue continues. CMS is going to continue to gather and evaluate stakeholder input, and may revisit the issue in future years. AKF will continue to work to ensure that transplant patients have access to the full range of immunosuppressive medications under Medicare Part D.

Nikia Okoye is Director of Government Relations for the American Kidney Fund

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