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Medicare Part D’s Six Protected Classes

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.

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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.

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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.

Jagger Esch

Jagger Esch

Medicare Educator
Jagger Esch is the Medicare Educator 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.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

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