Letter to Congress Re: Drug Benefit Design

Dear Member of Congress –

MAPRx brings together beneficiary, patient advocacy, family caregiver and health professional organizations committed to improving access to prescription medications and safeguarding the well being of beneficiaries with chronic diseases and disabilities under the Medicare prescription drug benefit (Part D). On behalf of millions of Medicare beneficiaries with chronic conditions who rely on Part D for essential medications, we urge you and your fellow Members of Congress to consider the strengths and weaknesses of Part D and use lessons learned from this program as you address the challenges ahead. Specifically, as you examine ways to reduce federal spending, reform federal health care programs, and oversee State health exchange implementation.

While not perfect, Part D’s success and popularity suggests that the program is working well for many Medicare beneficiaries. As we enter a new era of healthcare, it is imperative that policymakers and key stakeholders work together to design prescription drug benefit programs that meet the needs of people with chronic diseases and disabilities.

MAPRx urges policymakers to learn from the experience with Medicare Part D – build on its successes and improve on its limitations. To that end, we encourage you to use of the attached MAPRx Principles for Prescription Drug Benefit Design as a guide for the future development of prescription drug programs. Robust formularies, coverage of the six- protected classes, strong oversight, and transparency for consumers are among the design principles essential to meet the needs of beneficiaries. In addition, a process for notice of non-coverage, appeals and exceptions is key to providing access to needed drug therapies.

We also encourage policymakers to improve on the limitations of Part D. Medicare Part D is by no means perfect – key limitations prevent beneficiaries from taking full advantage of the benefits of prescription drug therapy. Policymakers should understand these limitations, including gaps in coverage, onerous cost-shifting created by specialty tiers, and restrictive utilization management tools. We also urge policymakers to be attentive to issues related to program effectiveness for beneficiaries receiving low income subsidies.

Thank you for considering our comments. Should you have questions related to MAPRx or the principles, please contact Bonnie Hogue Duffy, MAPRx Coalition convener, at (202) 429-4017 or by email at Bonnie@maprxinfo.org


MAPRx Members