Title: Expressing support for the protection of Medicare part D's six protected classes.
Policy area: Health

Summary:
This resolution expresses support for the six protected classes of prescription drugs under the Medicare prescription drug benefit: antidepressants, antipsychotics, anticonvulsants, immunosuppressants, antiretrovirals, and antineoplastics.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 1390 Introduced in House (IH)]

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117th CONGRESS
  2d Session
H. RES. 1390

    Expressing support for the protection of Medicare part D's six 
                           protected classes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 22, 2022

 Mrs. Napolitano (for herself, Mr. Katko, Ms. Lee of California, Miss 
  Gonzalez-Colon, Mr. Fitzpatrick, Ms. Roybal-Allard, Ms. Matsui, Mr. 
 Soto, Mr. Trone, Mr. Sires, Mr. Grijalva, and Mr. Cardenas) submitted 
the following resolution; which was referred to the Committee on Energy 
and Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                               RESOLUTION


 
    Expressing support for the protection of Medicare part D's six 
                           protected classes.

Whereas Medicare part D was established by Congress in 2003 to provide much-
        needed prescription drug coverage for seniors and people with 
        disabilities;
Whereas during implementation, the Centers for Medicare & Medicaid Services 
        (CMS) identified six classes and categories of medicines where patients 
        could face serious risks, complications, and negative health outcomes 
        without access to these medicines;
Whereas CMS requires part D plans to cover all or substantially all medication 
        within these six classes, which help protect patients needing 
        antidepressants, antipsychotics, anticonvulsants, immunosuppressants, 
        antiretrovirals, and antineoplastics;
Whereas these medications help treat patients with, but not limited to, 
        epilepsy, organ transplants, cancer, HIV/AIDS, and mental health 
        conditions;
Whereas, in the past, CMS has considered changes that impact the accessibility 
        of these medicines;
Whereas prior proposed changes would have permitted certain health plans to 
        limit or reduce coverage of drugs in the protected classes;
Whereas prior proposed changes have failed to consider the need for Medicare 
        beneficiaries to have access to treatments that are best for their 
        condition(s) or the necessity and challenges to determine the best 
        regimen to meet those needs;
Whereas if patients are unable to obtain the medicines they need, many will 
        experience costly and avoidable complications that could increase 
        overall costs to the Medicare Program, reduce their quality of life, or 
        even limit life itself;
Whereas such changes would directly target some of our most vulnerable citizens;
Whereas prior proposed changes are particularly worrisome given the unique, 
        often complex, medical needs of some Medicare beneficiaries;
Whereas beneficiaries with schizophrenia who are stabilized on medication and 
        then forced to utilize a different medicine are at risk of a relapse;
Whereas this would lead to higher medical costs in the form of potentially 
        avoidable psychiatric hospitalizations, as well as exacerbate patients' 
        comorbid medical conditions;
Whereas individuals with depression often need to try several medicines before 
        finding one that provides symptom relief;
Whereas having only one or two drugs to treat the wide-ranging ways someone 
        could present with depression is simply inadequate, especially among an 
        older population where depression is a significant predictor of suicide;
Whereas access to medications is essential for those who experience mental 
        health conditions, which are often co-occurring with other conditions, 
        such as Parkinson's disease;
Whereas for people living with HIV, new drug therapies have saved millions of 
        lives and prolonged millions more;
Whereas the advent of antiretroviral medications shifted the prognosis for an 
        individual diagnosed with HIV from a near-certain death to a manageable 
        disease, when patients have access to quality care and medications;
Whereas not all HIV/AIDS medications are the same, and each person may react 
        differently to a particular medication;
Whereas disruptions or delays in access to HIV treatment can have serious 
        consequences for patients and can increase the risk of HIV transmission 
        to others;
Whereas for people living with HIV, drug resistance can occur, and they must 
        have the ability to switch to another drug without interruption;
Whereas HIV disproportionately affects minority populations, and, in 2020, 43 
        percent of people newly diagnosed with HIV were Black, although Black 
        Americans represent only 12 percent of the United States population, and 
        in 2019, Hispanic people represented 29 percent of those newly diagnosed 
        with HIV but only 16 percent of the United States population;
Whereas access to oncology drugs (antineoplastics) is crucial for cancer 
        patients because drugs in these classes are not always interchangeable;
Whereas oncology patients may respond differently to different treatments, need 
        to access alternative treatments based on changes in their condition, or 
        have fewer or more tolerable side effects if they use one therapy 
        instead of another;
Whereas at least 1,100,000 Medicare beneficiaries live with epilepsy;
Whereas epilepsy medications, known as anticonvulsants or antiseizure 
        medications, are not interchangeable;
Whereas people with epilepsy who cannot access or are forced to switch from the 
        most effective anticonvulsant are at increased risk of breakthrough 
        seizures and related complications including injury, disability, and 
        death;
Whereas seizure-free individuals who are forced to switch their medication have 
        nearly a 17-percent rate of seizure reoccurrence compared to less than 3 
        percent among people remaining on the most effective medication;
Whereas eliminating immunosuppressants from the list of protected classes would 
        place persons who received any transplant at risk for severe medical 
        complications;
Whereas immunosuppressive medications are not interchangeable;
Whereas if prescription drugs are filled without regard to consistency from one 
        month to the next, the recipient is subject to increased risk of organ 
        rejection, along with additional clinic visits, lab costs, and potential 
        hospitalization;
Whereas this includes individuals who take these same medications to manage 
        their autoimmune disorders, including lupus, psoriasis, rheumatoid 
        arthritis, Crohn's disease, and multiple sclerosis;
Whereas part D plans are already equipped with tools to manage spending and 
        encourage the use of generics, when possible and appropriate, for the 
        six protected classes;
Whereas, according to an analysis of CMS data by the Pew Charitable Trusts, the 
        generic utilization rate in the six protected classes is as high as 92 
        percent; and
Whereas potential changes to the six protected classes have now been rejected 
        during the Obama, Trump, and Biden administrations after receiving 
        significant opposition from Congress, patient groups, providers, and 
        stakeholders: Now, therefore, be it
    Resolved, That the House of Representatives--
            (1) supports the six protected classes policy because it 
        established critical access protection for many of our most 
        vulnerable Medicare beneficiaries;
            (2) recognizes that Medicare part D beneficiaries currently 
        needing antidepressants, antipsychotics, anticonvulsants, 
        immunosuppressants, antiretrovirals, and antineoplastics depend 
        on the protection of the six protected classes to meet their 
        complex medical needs and highly personalized treatments; and
            (3) encourages the Centers for Medicare & Medicaid Services 
        to continue to work with Congress, patient groups, providers, 
        and stakeholders to secure long-term protection of the six 
        protected classes policy.
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