Medicare Part D’s Six Protected Classes

The Centers for Medicare and Medicaid Services (CMS) holds a policy requiring Part D plans to include a full range of drugs in six classes on their formularies. The purpose of this policy is to help people with chronic conditions get the treatment they require.

The six protected classes of drugs under Part D are:

1. Anticonvulsants
2. Antidepressants
3. Antineoplastics
4. Antipsychotics
5. Antiretrovirals
6. 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 Part D have access to the prescriptions they need. People who have access to medications are more likely to live longer, healthier lives.

Some 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 treat HIV and AIDS patients.

Step therapy consists of the patient trying less costly prescriptions first. If the initial prescriptions are ineffective or the patient has adverse effects, they are able to obtain a more expensive prescription. The purpose of this is to see if a lower-cost medication suffices so the plans can control costs.

Part D plans can only implement step therapy when a patient is newly starting treatment. This means that step therapy cannot apply to existing prescriptions.