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Saving Money Shouldn’t Mean Hurting Grandma

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Concerned Women for America (CWA) has always fought to protect life from its beginning at conception until natural death. A recent hospital stay and subsequent medical care for my 80-year-old mother has served as a wakeup call to the particular vulnerability of the elderly.

With this top of mind while caring for her in Tennessee, I was struck and surprised when I learned via a TV ad about a new proposed government regulation which is particularly onerous for seniors.

The Department of Health and Human Services (HHS) has revived a plan, first proposed during the Obama administration, to restrict access to prescription drugs to some of our sickest and most vulnerable senior citizens.

Since the beginning of the Medicare Part D Prescription Drug program, signed into law by the Bush administration, the medical community has recognized that there were some areas of medicine such as Cancer Treatment, Organ Transplants (including kidneys), Autoimmune Disorders, Mental Health, HIV/AIDS, Epilepsy, and Parkinson’s that were both life-threatening and extremely complex.  Fortunately, a large variety of drugs were available to treat the many different faces of these complex diseases.

In designing the Part D program, Congress understood that one set of drugs in these particularly difficult disease areas may not meet the needs of all patients, so it established what is known as the “Six Protected Classes Policy.”  This policy simply requires that all Part D plans cover the full variety of drugs available to treat these complex diseases.

Today, we are told by the well-intentioned HHS officials that we need to eliminate this tried and true “Six Protected Class Policy” in order to save money.  Plans, they say, must be able to, in effect, ration drugs by forcing seniors to first try and fail on cheaper drugs.  They also say plans need to be allowed to force seniors into a lengthy prior-approval process.  Prior approval amounts to a doctor begging a plan for the drugs they know in their professional opinion that their individual patient needs.  Meanwhile, the patient suffers during delays in care.  I fear this delay could have a severe or even lethal impact.  With her permission, I have already shared publicly about my mom’s life-long fight against clinical depression.  Medications for mental illness are particularly important due to the potential for increased risk of suicide for these patients.  My family has lived this heart-breaking scenario, and I know this is a real threat.

Imagine a patient stabilized on a pre-existing drug treatment plan who is then forced to abandon that successful course of drug treatment when they reach 65 and move onto Medicare.  The same could happen to a patient who is already in a Medicare Part D plan and chooses to change plans during the annual open season.

We all agree health care costs need to be contained, but we must do it in a way that does not jeopardize the care of those whose unique medical needs require a specific drug.  Seniors should have access to the medicine they need, just as they do today.

CWA spoke out in the effort to repeal another Medicare rationing scheme, IPAB, the Independent Payment Advisory Board, which was aptly named a “death panel.”  We succeeded in repealing that Obama-era, bureaucratic policy which cynically traded the length and quality of a senior’s life for government savings.  By repealing IPAB, we restored the principle that the government should honor the doctor’s best professional judgement in protecting life.

Eliminating guaranteed access to critical drugs to some of our most vulnerable seniors is a step backward, and although well-intentioned, it is just wrong.  It is not a necessary step for a Part D program that is already doing an effective job of cost containment, nor is it morally right to leave our most vulnerable seniors behind.

HHS needs to rethink this unwise proposal to eliminate the “Six Protected Classes” policy and recognize this is the wrong way to control costs.