Joint Press

Lawmakers Seek Lower Drug Costs and Fair Appeal Rights for Chronically Ill Seniors


Bryan Gulley, for the Senate Aging Committee, 202-224-0101  
Jen Burita, for Sen. Collins’ office, 202-224-9229
Andy Phelan, for Rep. Johnson’s office, 770-987-2291
Lee Whack, for Rep. Schakowsky’s office, 202-225-2111
Jim Forbes, for Rep. McKinley’s office, 202- 226-3403
Mike Casca, for Rep. Ellison’s office, (202) 225-4755

WASHINGTON, DC – A bipartisan group of six House and Senate lawmakers today urged the Center for Medicare and Medicaid Services (CMS) to take steps to improve Medicare beneficiaries’ access to needed medications.

In a letter to CMS Administrator Marilyn Tavenner, the lawmakers urged Medicare to make it harder for plans to put drugs on the restricted so-called specialty tier, where patients have to pay from 25 to 33 percent of the drug's total cost - rather than a flat copayment rate.  Once a medication is placed on the specialty tier, Medicare Part D beneficiaries are prohibited from seeking exemptions from their plans that could lower their cost-share for specialty drugs - a basic right beneficiaries have throughout the rest of the program.  The lawmakers also pushed the agency to  take several steps to make it easier for beneficiaries to file an appeal and receive immediate assistance throughout the program.  

The letter was spearheaded by the chairman and ranking member of the Senate Special Committee on Aging, Sens. Bill Nelson (D-FL) and Susan Collins (R-ME), along with U.S. Reps. Hank Johnson (D-GA), Jan Schakowsky (D-IL), David McKinley (R-WV) and Keith Ellison (D-MN).   The lawmakers letter came in response to the Agency’s recent release of the draft annual 2015 Medicare Part D guidance to plans which proposed leaving the outdated specialty tier guidelines in place for the seventh year in a row, despite reports that the number of drugs being placed on this tier of plans’ formularies has increased over 90 percent since 2006.

“If beneficiaries are to have their appeal rights restricted for these drugs, then the tier should only reflect truly high-cost and unique items,” the lawmakers wrote.  “The Medicare Part D appeals process should be transparent, easy-to-understand, and fair in order for it to function as a true recourse for beneficiaries.”

Currently, insurers are allowed to place medications costing more than $600 on a specialty tier that requires Medicare Part D beneficiaries to pay a significant share of the drug's total cost .  These medications, used to treat serious illnesses such as cancer and multiple sclerosis, have long come under fire from patient advocates for being too expensive for many Medicare beneficiaries to afford.  For many seniors, the out-of-pocket costs for these life-saving drugs for can be as high as $3,000 per month.  Seniors who can't afford the medication report they often go without treatment.

The six lawmakers are sponsors of legislation filed in both houses last year giving Medicare Part D beneficiaries the right to appeal for a lower co-pay for drugs placed on the specialty tier.  The Senate bill is  S. 1365;  the House measure is H.R. 2827.

Download Text of Letter Here CMS Part D Appeals Letter