Medicare’s Protected Classes of Drugs

CMS is proposing to give Medicare Part D and Medicare Advantage plans the option to limit coverage of drugs in six categories — known as the “protected classes” — in a bid to lower pharmaceutical costs. The agency posted a proposed rule in the Federal Register on Nov. 30, available for public comment through Jan. 25, that would give health plans the ability to exclude protected class drugs from medication prescription lists in certain instances. The changes are estimated to save the government about $1.9 billion over 10 years and save Medicare enrollees$692 million in cost sharing.

CMS is proposing to give Medicare Part D and Medicare Advantage plans the option to limit coverage of drugs in six categories — known as the “protected classes” — in a bid to lower pharmaceutical costs. The agency posted a proposed rule in the Federal Register on Nov. 30, available for public comment through Jan. 25, that would give health plans the ability to exclude protected class drugs from medication prescription lists in certain instances. The changes are estimated to save the government about $1.9 billion over 10 years and save Medicare enrollees$692 million in cost sharing.