There are six Medicare-protected drug classes that Medicare Part D formularies must include. This rule helps ensure that people with serious health conditions have access to life-saving medications for treatment. Below we review the six protected Medicare Part D drug classes and how you can receive access to these drugs through your Medicare prescription drug plan.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
What are the Six Medicare Protected Drug Classes?
Medicare Part D helps to cover the cost of prescription drugs for those on Medicare. To ensure Medicare Part D beneficiaries with certain health issues receive the care they require, the Centers for Medicare & Medicaid Services (CMS) states that all Medicare Part D plans must include at least two drugs in each of the six protected classes on their formularies. The purpose of this policy is to help people with chronic conditions get the treatment they require without fear that their Medicare Part D plan will not cover their drugs.
The six protected classes of drugs under Part D are:
- Anticonvulsants
- Antidepressants
- Antineoplastics
- Antipsychotics
- Antiretrovirals
- Immunosuppressants
By ensuring access to these prescriptions, patients are in a better position to continue treatment for conditions, such as:
- Epilepsy
- Mental illness
- Cancer
- HIV/AIDS
- Organ transplantation
Regardless of the cost of these drugs, the six protected classes policy ensures that patients on a Medicare Part D plan have access to the prescriptions necessary to treat their medical issues. People who have access to medications are more likely to live longer, healthier lives. Plus, this rule reduces the stress of comparing covered drugs and reviewing formularies when enrolling in a Medicare Part D plan.
What is Medicare Part D Step Therapy
Some Medicare Part D plans involve step therapy, a type of prior authorization, for drugs in five of the six protected classes. The only class of drugs to which step therapy cannot apply is antiretrovirals, which are used as a treatment for those with HIV and AIDS.
Step therapy consists of the patient trying less costly prescriptions first and then working their way to higher-tier medications if necessary. If the initial prescriptions are ineffective or the patient has adverse reactions, they can obtain a more expensive prescription to treat their health condition. The purpose of this is to see if a lower-cost medication suffices so the insurance plan can control costs.
Medicare Part D plans can only implement step therapy when a patient newly starts treatment. This means that step therapy cannot apply to existing prescriptions. This means if you switch Medicare Part D plans immediately after a doctor prescribes you a medication, step therapy will not apply.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
How to Get Help With Medicare's Protected Drug Classes
Access to medications to treat chronic conditions is of utmost importance. The six Medicare-protected drug classes ensure Medicare seniors have adequate access to treatment and can receive the care they deserve.
If you or a loved one requires a drug that falls into one of the six protected classes, it is essential to enroll in a Medicare Part D plan to receive treatment. If you are interested in enrolling in or comparing Medicare Part D plans, fill out our online rate form, and an agent licensed in your state will be in touch with you.
Drug coverage is essential while on Medicare, so don’t wait to enroll in Part D.
Enter ZIP Code
Enter your ZIP code to pull plan options available in your area.
Compare Plans
Select which Medicare plans you would like to compare in your area.
Get Quote
Compare rates side by side with plans & carriers available in your area.
