Patient Characteristics Vary Across Part D Protected Drug Classes (Health Update)

Current Medicare Part D policy requires sponsors to cover with limited exceptions “all or substantially all” drugs in six “protected” classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants for treatment of transplant rejection, antiretrovirals and antineoplastics. Overall, in 2016, 18 million Part D enrollees took at least one drug in one of the six protected classes, and the total spend for protected class drugs was 19 percent of total Part D spend. In the CY 2020 Medicare Part D proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposed to give Part D sponsors more tools such as prior authorization and step therapy to manage formularies within protected classes.

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