Medicare Part D's Six Protected Classes

Medicare Part D’s Six Protected Classes

Updated on October 6, 2021

Written By: Jagger Esch

There are six protected classes of drugs that Part D formularies must include. This rule helps to ensure that people with serious health conditions have access to a full range of medications for treatment.

What are the Six Protected Classes of Drugs?

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:

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 Part D have access to the prescriptions they need. People who have access to medications are more likely to live longer, healthier lives.

What is Medicare Part D Step Therapy

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.

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How to Get Help With Medicare Part D

Access to the medications needed to treat chronic conditions is of utmost importance. The six protected classes ensure Medicare beneficiaries have this access.

If you or a loved one has any questions regarding Part D or the six protected classes, please give us a call today at the number above. If you're interested in signing up for a Part D plan, fill out our online rate form and an agent licensed in your state will be in touch with you.

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Jagger Esch

Medicare Expert
https://www.medicarefaq.com/

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.