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Medicare Part D Redesign Will Sharpen Policy Focus On Protected Classes

 
• By Cathy Kelly

Manufacturers worry that the redesign will prompt tighter controls in the protected classes, while some research indicates plans are already using all the tools at their disposal to manage some key classes, such as cancer drugs, suggesting they may need to be able to do more.

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With Costs Growing, Particularly For Cancer Drugs, The Focus On Protected Class Won't Go Away • Source: Shutterstock

Upcoming changes in the Medicare Part D benefit that involve increasing the risk borne by insurers in the catastrophic phase may boost pressure on plans to control costs in the six protected classes and manufacturers are worried about what that might lead to.

Key Takeaways

  • Manufacturers are worried that the incentives to better manage costs imposed on Part D plans by the Inflation Reduction Act might lead to stricter management of the protected classes.

  • It seems unlikely that policymakers will make major changes in the protected classes policy in the near-term

Under the Inflation Reduction Act, Part D plan obligations for drug costs will increase from 15% to 60% in the catastrophic phase beginning in 2025, while

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