A coalition of more than 50 patient advocacy and medical groups is warning that a Trump administration proposal to reduce certain Medicare drug prices “will put patients’ lives at risk.”
Their ad comes in response to recent Trump administration proposals that would allow private Medicare prescription drug plans to place additional limits on what drugs certain patients can use.
Those Medicare plans are currently required to cover “all or substantially all” drugs in six “protected classes,” including antiretrovirals used to treat HIV and AIDS; immunosuppressants used to prevent organ rejection; antidepressants; antipsychotics used to treat schizophrenia and related disorders; anticonvulsants used to treat epilepsy; and antineoplastics used to treat cancer. For diseases not in the protected classes, Medicare plans are only required to cover two drugs per condition.
Under the Trump administration proposal introduced in November, private Medicare plans would be allowed to exclude from their formularies drugs that experience price increases greater than inflation or some new drugs that don’t represent a “significant innovation” over previous versions. The proposal would also allow insurers to require that patients get prior authorization to use drugs in the protected classes and to require patients to try less expensive drugs first.
Trump administration officials have argued that the protected classes leave little negotiating power with drugmakers, leading to higher costs.
The new ad campaign says that the administration’s proposals “could interfere with what doctors think is the best course of treatment for their patients and if finalized, could delay patients’ access to lifesaving innovative therapies.”
In addition to the American Cancer Society’s advocacy arm, the dozens of groups that have signed on to the new ad also include the American Medical Association, the American Heart Association, the American Society of Clinical Oncology and Susan G. Komen for the Cure.
Why it matters: The pushback from these groups illustrates how narrow a tightrope the administration is walking as it seeks to lower drug prices via increased competition and negotiation.