The Center for Medicare & Medicaid Services (CMS) announced today a decision to drop its proposal to remove drugs from protected class status under Medicare Part D. This means transplant recipients will continue to have access to all immunosuppressive drugs under their Medicare Part D plan. In a letter to Representative Henry Waxman, Ranking Member of the House Energy and Commerce Committee, CMS Administrator Marilyn Tavenner stated that the agency will not move forward this year with its January proposal to remove immunosuppressive medications, antidepressants and antipsychotics from protected class status. The letter states that the agency may revisit the issue in future years.
This is a wonderful win for the kidney community that has worked tirelessly to fight this CMS proposal. NKF’s government relations staff has met with White House policy advisors, the Deputy Principal Administrator of CMS, and Congressional office staff to educate them about why restricting access to immunosuppressive drugs would be harmful to patients. Thanks to the input of our transplant physician volunteers and the stories shared by many of you, we were able to make a convincing case as to why CMS should not move forward with its proposal. Key to our success was the support of many other patient advocacy organizations, transplant associations and coalition groups who helped schedule meetings with Congressional staff and Administration staff and who attended meetings side by side to ensure that the six protected classes of medications under Medicare Part D were preserved.
Thank you to all of you for helping us achieve this important goal. Our work is not over and we will continue to work with CMS to ensure that patients maintain this access to all immunosuppressive drugs under Medicare Part D in the future.
Awesome news. Thank you very much for pressing on. I am so happy for those affected by this wonderful response of CMS.
I have been following this closely. As an insured post transplant patient, this may one day affect me. A happy day for many people.
Thank you so much…This may be a lifesaving decision for my future as a kidney transplant patient.
My husband is currently trying to appeal with his prescription drug plan – Well Care.
He has been on Azathioprine for 33 years for his 2nd kidney transplant. The letter says they
have denied coverage under the Medicare Part D benefit. If the (CMS) has dropped its proposal
to remove drugs from protected class status under Medicare Part D why doesn’t the prescription
drug plan know about this from Medicare?? This is very…..very upsetting!!!! If you could offer any assistance with this problem…..it would be greatly appreciated!
Unfortunately the protected class status for immunosuppressive drugs only applies to stand alone Part D plans and doesn’t apply to Medicare Advantage Prescription Drug Plans. I know that’s silly seeing as they are both Medicare programs. It appears Well Care is a Medicare Advantage Plan and that’s why they are able to deny the coverage if the drug is not on their formulary. I would contact your husband’s doctor to see if they can overturn the decision – most of the time this is a pretty easy process when it comes to immunosuppressive drugs, particularly if he was on the medicine previously. As a last resort there is a Medicare appeals process, which I can give you more information on, but it can be a lengthy process. Please feel free to email me at firstname.lastname@example.org if you need more information.
Senior Federal Health Policy Director
National Kidney Foundation
I was wondering if medicare part b continued to pay for immuno drugs ater lung transplant and how long
Hi Barbara, I’m not sure about Medicare and immunosuppressants for lung transplant recipients. I would suggest contacting the social worker at your transplant center to ask them.
Constituent Services Director
National Kidney Foundation