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March 3, 2021

Open Letter to Ohio’s Congressional Delegation Concerning Rule Change in the Six Protected Classes of Medicare Part D

The organizations undersigned on this letter advocate for Ohioans with critical needs for medication. Our patients must have dependable, affordable access to medicines that allow for optimal physical and mental health, and in some cases, to keep them alive.

We are writing to raise our concern for a recent action that impacts the affordability and accessibility of medicines offered through Medicare Part D. The Six Protected Classes of medications offered in Medicare Part D is subject to a change that will reduce availability of critical medicines for patients with complex medical needs.

On the final day of the Trump administration, the Center for Medicare and Medicaid Innovation (CMMI) modified the Part D Payment Modernization Model, to allow for significant changes to Medicare prescription drug coverage starting in 2022. The changes are aimed at medicines in the Six Protected Classes which are:
▪ Anticonvulsants, which treat epileptic seizures.
▪ Antidepressants, which treat depression and other psychiatric illnesses.
▪ Antineoplastics, which prevent or inhibit the growth of cancerous tumors.
▪ Antipsychotics, which treat acute psychosis, schizophrenia, and bipolar disorder.
▪ Antiretrovirals, which treat HIV.
▪ Immunosuppressants, which prevent organ rejection in transplant patients.

The modifications would drop the requirement that all drugs included in the six protected classes are covered on plans’ Part D formularies. Drugs in the HIV class would have a one-year delay until protection status would also be removed in 2023. Any plan participating in this CMMI model would be permitted to include only one drug on the formulary in each of the six protected classes, a further reduction from the current standard of two drugs per class throughout Part D.
These changes will impact thousands of Ohioans with complex illnesses, who depend on protections that ensure that the treatments they need are available to them. The changes will reduce the variety of prescription drugs needed by people with mental illness, cancer, HIV, seizure disorders, and people who have had organ and tissue transplants.

We ask that our federal lawmakers preserve the integrity of the Medicare Part D program and its six protected classes. The patients we serve must have access to the full range of treatment options to ensure physicians and patients can address individual medical needs.

On behalf of the Ohio patients we serve, we urge you to encourage the Biden administration to stop the Six Protected Classes model from moving forward.

Thank you for considering our request.

Academy of Medicine of Cleveland and Northern Ohio
American Liver Foundation
Beacon Charitable Pharmacy
Charitable Healthcare Network Ohio
Cincinnati Area Senior Services
Equitas Health
Easter Seals Central and Southeast Ohio
Epilepsy Association
Epilepsy Foundation Ohio
Healing Hearts of Central Ohio
Kidney Foundation of Ohio, Inc.
Mental Health America of Ohio
Prevent Blindness Ohio
National Alliance on Mental Illness Ohio
Ohio Foot and Ankle Medical Association
Ohio Osteopathic Association
Ohio Pharmacists Association
Ohio Psychological Association
Ohio Public Health Association
Ohio State Grange