White House Drops Plan to Limit Medicare Coverage for Certain Drugs

By Paul Gaita 03/12/14

President Obama staved off a potentially brutal fight with Republicans over changes in Medicare's prescription drug benefit.

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The Obama administration began the week by withdrawing a proposal that would have removed three classes of prescription drugs – antidepressants, antipsychotics, and immunosuppressant drugs used for transplant patients – from full Medicare coverage and limited seniors’ access to these medications.

In a letter sent to Congress on Monday, Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, announced that the proposal had been shelved. “Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time,” she said.

In addition to the Medicare limits, the White House has also put a hold on three additional proposals: one that would prevent insurers from offering more than two prescription drug plans to Medicare patients in the same region; a second which would require insurers to offer contracts to retail drugstores in order to expand patient access to smaller community pharmacies; and a third that would grant the government the right to intervene in negotiations between insurers and pharmacies.

The administration’s move to drop these proposals helped to head off what would have undoubtedly been another painful loss at the hands of the Republican-controlled House of Representatives. The House was expected to pass North Carolina Representative Renee Ellmers’ proposed legislation, Keep the Promise to Seniors Act, which would have blocked the White House measures.

The plan to limit coverage to the aforementioned drug classes was initially seen as a cost-saving measure for Medicare patients, who would have saved an estimated $729 million by 2019. But it came under a withering barrage of criticism from both parties, including a bipartisan group of 40 senators, as well as more than 350 health care organizations.

Republican Congressman Tim Murphy of Pennsylvania, a clinical psychologist, crystallized concerns about the plan’s effect on antidepressants and antipsychotics by stating “medications impact a person’s brain and body in unique ways. That’s why physicians and patients with serious mental illnesses often try different therapies until they find the right one.”

According to the Geriatric Mental Health Foundation, about six million Americans over the age of 65 are prescribed antidepressants to combat the effects of depression.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.