Proposed Medicare drug rule change draws criticism

An alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is opposing an Obama administration proposal that would allow insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia (Source: “Plan to Limit Some Drugs in Medicare Is Criticized,” New York Times, Feb. 21, 2014).

Opponents warn that the proposal, if enacted, could harm patients. Federal officials say it would lower costs and reduce overuse of the drugs.

The proposed rule, which would lift a requirement that insurers cover “all or substantially all” drugs in certain treatment areas, is just one of a series of proposed changes to the drug program.

Even insurers and drug benefit managers, who have previously supported added limits on drug coverage, oppose the rule. They object to provisions including changes to “preferred pharmacy networks,” where consumers are steered toward a limited network of pharmacies, and to reducing the number of plans that insurers can offer in any one region.