Medicare Backs Down on Proposed Restrictions on Immunosuppressants

March 11, 2014

The Center for Medicare & Medicaid Services has reversed a plan to alter Medicare Part D plans, including proposed restrictions on immunosuppressants. A coalition of 44 support groups, including many for rheumatology patients, had written a joint letter objecting to a proposal to eliminate blanket approval of immunosuppressants, pointing out the need for individualized treatments.

Adding to bipartison protests from members of Congress, a

, submitted by a coalition of 44 voluntary organizations including many that represent patients with rheumatologic conditions, strongly objected to a January 6 proposal to remove blanket approval for immunosuppressant drugs under Medicare Part D for 2015. On March 10, CMS Administrator Marilyn Tavenner announced that plans for changes to Part D had been dropped.

Currently "all or substantially all" drugs in six classes--antineoplastics, anticonvulsants, antiretrovirals, antipsychotics, antidepressants, and immunosuppressants--are covered under Medicare Part D. CMS had proposed to remove antidepressants and immunosuppressants from this provision, requiring them to be covered individually under formularies as are most kinds of medications.

'Individuals with complex care needs require unique strategies to manage their care," says the letter from the patient support groups, which mentions a long list of rheumatic disorders and "other diseases of unmet need" that require individually tailored treatments. The proposal ignored important variations between patients in efficacy, safety, and tolerability, it adds, observing that the proposal would lead ultimately to worse complications, higher costs, and an increase in health disparities.

Cosigners include the Arthritis Foundation, the Lupus Research Institute, the Vasculitis Foundation, and many others with an interest in rheumatologic conditions.