Why are Medicare Part D’s six protected classes important for patients?

Test Name
Test Title, Test Company

Read biography×

Why are Medicare Part D’s six protected classes important for patients?

This year, more than 136,000 Americans will be diagnosed with Colorectal Cancer. Nearly 50,000 will die from the disease. But here's the good news -- there are more than 1M survivors!!  When discovered early, colon cancer is highly treatable. Even at more advanced stages, colon cancer patients are living nearly three times longer - from months to years - from only a decade ago. Clearly, access to treatments is an essential piece of that success and that's where Medicare policy becomes very imortant.

The average age of a patient receiving this diagnosis is 70 and 90% of all patients diagnosed are over 50. For a majority of patients, access to treatments will be through Medicare. Thus the protected classes policy within Medicare Part D is of enormous importance to patients and their families.

This policy protects colon cancer, and indeed all cancer patients who have Medicare Part D coverage, by requiring “all or substantially all” medications within six important classes of medicines be covered by every Part D Medicare plan.  Antineoplastics, medications used for the treatment of cancer, is one of these protected classes.  

Cancer treatments must be precise and consistent. Under the protected classes’ policy, plans who provide Part D coverage are also prohibited from imposing step therapy or prior authorization requirements for these drugs. This ensures that patients have continuing access to the exact regiment they are prescribed, even if they are transitioning between plans. Thus, the Medicare 6 protected classes policy is of the highest importance to our organization and to patients and their families. 

Andrew Spiegel
,

Read biography×

Andrew Spiegel
,

Andrew Spiegel has a long and personal history in the patient advocate community. In 1998, Spiegel’s mother was diagnosed with metastatic colon cancer. She exhibited numerous symptoms, which were ignored by her physicians, and died nine months later. In a most odd and unfair twist, toward the end of his mother’s life, Spiegel’s father was diagnosed with pancreatic cancer and he died two days before Andrew’s mother. It was then that Spiegel knew the rest of his life would be spent in the patient advocacy world.

Because there was already a patient advocacy group for pancreatic cancer (PANCAN), Spiegel and a group of others founded the Colon Cancer Alliance, now the leading US based national patient advocacy organization dedicated to colon cancer. Mr. Spiegel, an attorney, besides being a co-founder of the organization and longtime board member of the Alliance became CEO in January of 2008 and he ran the CCA for nearly 5 years, before undertaking his next venture, the Global Colon Cancer Association (GCCA).

Currently, Spiegel is co-founder and executive director of the GCCA, an international patient advocacy organization. This organization is an international community of colon cancer patient advocacy organizations and stakeholders dedicated to end the worldwide suffering of the 2nd leading cause of cancer deaths.

In addition to his work in the colon cancer community, Spiegel is an active advocate for healthcare policies both in the US and now worldwide. He is a frequently invited speaker in this arena. Spiegel is a member of the National Colorectal Cancer Roundtable and is on the Stand Up to Cancer Advocate Advisory Council. He is a co-founder and currently serves on the steering committee of the Alliance for Safe Biologic Medicines. He is on the Board or Directors and in December 2014 was elected to Chair of the Digestive Disease National Coalition (DDNC), is a member of the Coalition for Imaging and Bioengineering Research and is a member of the Computerized Tomography Coalition, a founding member of the Coalition to Increase Clinical Trial Participation as well as an active member of many other health care coalitions and organizations.

In 2012, Spiegel received the David Jagelman Award for Patient Advocacy from the American Society of Colon and Rectal Surgeons. In March, 2013, Spiegel was nominated as Exact Science’s first Hero of the Month. In August of 2014, Spiegel received the C-Change Together, Hidden Hero Award.

Spiegel is a 1986 graduate of Temple University in Philadelphia where he earned a Bachelor’s degree in Political Science with minors in English and Philosophy. He is a 1989 graduate of the Widener University School of Law where he was an editor of the Delaware Law Forum, an invited member of the Phi Delta Phi legal honors society and a member of the Moot Court Honor Society. After working for a Philadelphia litigation firm, Spiegel opened his own law firm in 1995 and was a participating member of numerous legal organizations in the region.

×

Why are Medicare Part D’s six protected classes important for patients?

As a person who has been living with HIV for over 20 years, I am a first-hand witness to the miracles that have been achieved by the development of life-saving medicines.  In 2015, we are in a place that could not have been imagined 25 years ago -- people with HIV and AIDS are living long enough to be eligible for Medicare!

Being successful in combating HIV infection and in containing progression to AIDS requires a complex series of medicines which must be taken with precision. Having access to those drugs is critical. Therefore, the inclusion of antiretrovirals as one of the 6 protected classes of medicines in Medicare Part D is a victory on many levels. First and foremost, it is a victory because there is an array of medicines to treat people living with HIV and AIDS. We have learned, over the years,  that having a variety of medicines is not a luxury but a necessity in order to address mutations in the virus and the needs of individual patients.

 Another aspect of the victory is that by having antiretrovirals included in the 6 protected classes, people living with HIV and AIDS can LIVE into their senior years with certain knowledge that the medicines they need will be available to them.

Certainly more needs to be done in order to remove the effects of HIV infection completely. But good health is always the ultimate victory and the six protected classes of medicines help to make that possible for HIV/AIDS Medicare beneficiaries. 

Ronald Johnson
,

Read biography×

Ronald Johnson
,

Ronald S. Johnson currently serves as the Vice President of Policy and Advocacy of AIDS United, a national organization that achieves its mission to end the HIV/AIDS epidemic in the United States through national, regional and local policy/advocacy, strategic grantmaking, and organizational capacity building.  AIDS United was formed from the merger of AIDS Action and the National AIDS Fund.  Mr. Johnson had served as the Deputy Director of AIDS Action.

Prior to joining AIDS Action, Mr. Johnson served as the Associate Executive Director of Gay Men’s Health Crisis (GMHC).  In that capacity, he managed GMHC’s public policy, advocacy and government relations functions and served as a member of the senior management.  Prior to coming to GMHC in November 1997, Mr. Johnson served for five years in the Office of the Mayor, City of New York as the first Citywide Coordinator for AIDS Policy.  Mr. Johnson also has served as the executive director of a community-based organization in New York City, the Minority Task Force on AIDS.

Mr. Johnson has served on numerous boards of directors of non-profit agencies, including Gay Men’s Health Crisis, Lambda Legal, and the NAMES Project, and was a member of the Presidential Advisory Council on HIV/AIDS from 1996-2001.

×

Why are Medicare Part D’s six protected classes important for patients?

The U.S. Department of Labor has estimated that 80 percent of all healthcare decisions in the US are made by women and women make up slightly more than 55% of Medicare beneficiaries. Whether caring for themselves, their children, their parents or other family and loved ones, women, by far, have more experience with all aspects of our health care system, especially Medicare.

At  HealthyWomen we see this first hand, with more than one million monthly page views on our website (healthywomen.org) and 14 thousand Twitter followers coming to us  for information to help them make smart health choices for themselves and their families. We also see the difficulties that arise when patients encounter barriers that impede their access to treatment. Medicare's six protected classes system eliminates those barriers for millions of patients who need critically important medicines. This policy provides a much needed protection to vulnerable beneficiaries who suffer from very serious illness and. as such, is a cornerstone of maintaining good health. 

Lisa Tate
,

Read biography×

Lisa Tate
,

Lisa M. Tate is a health care executive, having served in leadership positions with a national nonprofit patient organization, hospital trade association, and medical society. Lisa most recently served as Interim Executive Director for HealthyWomen, the leading nonprofit health resource for women of all ages. Prior to HealthyWomen, she served as Chief Executive Officer of WomenHeart, the National Coalition for Women with Heart Disease, the only U.S. organization solely focused on the health and quality of care for women with heart disease.

 

×

Why are Medicare Part D’s six protected classes important for patients?

Behcet’s Disease is a rare autoimmune condition for which there is no cure.  For patients with Behcet’s, access to treatments for its many complex symptoms is their only hope.  And, like so many patients who suffer from one or more types of autoimmune disorders, the treatment of these symptoms often requires multiple medical experts who prescribe multiple medicines.

Speaking not only for Behcet’s patients but for autoimmune patients generally, access to a wide range of medicine can truly mean the difference between pain and relief, or even life and death. Medicare’s six protected classes policy helps to enable patients with complex medical issues to be treated precisely,  thereby giving them the best chance for relief and recovery.

In treating Behcet's and, indeed, in treating so many conditions, one medicine does not fit all patients.The six protected classes policy makes a huge difference in the lives of these patients and their families. 

Mirta Santos
Executive Director, American Behcet’s Disease Association (ABDA)

Read biography×

Mirta Santos
Executive Director, American Behcet’s Disease Association (ABDA)

Mirta Avila Santos, MD, joined the American Behcet’s Disease Association (ABDA) in 2011. She became the executive director of the organization in 2012. She is passionate about improving the lives of patients living with autoimmune diseases, rare diseases and Behcet’s Disease in particular. Under her guidance, the ABDA has expanded the mission of the organization, and has partnered with other patient advocacy organizations to provide better access and improved care for patients. Her research background has contributed to research efforts for patients with Bechet’s. Her past experience includes clinical research at Rush Presbyterian St. Luke’s and at West Suburban Hospital in the state of Illinois.  She was the clinical research coordinator at the Rochester Rheumatology Research Center for 12 years.  She serves as the “firewall” for a biomarkers study focusing on Behcet’s Disease in partnership with Keck Graduate Institute and the ABDA. Dr. Santos is a moderator for Behcet’s Syndrome on RareConnect, works closely with NORD’s membership board, with the Rare Disease Legislative Advocates (RDLA), and recently received one of the DIA’s Patient Advocate Fellowship Awards.  She volunteers her time as a patient advocate and works with patients, legislators and pharmaceutical industry. 

×

12/04/14: What should Medicare enrolled seniors and individuals living with disabilities be doing to take advantage of the Medicare Part D open enrollment period?

Back to Top

Contributors:

              
Bob Blancato , Executive Director, NANASP
Martha Roherty, Executive Director, NASUAD
Donna Butts, Executive Director, Generations United
Austin Curry, Executive Director, Elder Care Advocacy of Florida
Mary R. Grealy, President , HLC
Howard L. Rogers, III, Executive Director, NOCOA
Nona Bear, Community Health Care Activist, Seniors Speak Out

Join The Conversation

11/11/14: How can we best advance the science of patient input to improve the efficiency of the drug development and regulatory review process?

Back to Top

Contributors:

                
Marc M. Boutin, J.D., Executive Vice President & Chief Operating Officer, National Health Council
Robert Metcalf, Ph.D., Vice President, Global Regulatory Affairs – US & Global Medical Quality, Eli Lilly and Company
Peter L. Saltonstall, President and CEO, NORD
Sascha Haverfield , SVP, Scientific and Regulatory Affairs, PhRMA
Ryan Fischer, Vice President of Advocacy and Community Outreach, Parent Project MD
Sharon Terry, President and CEO, Genetic Alliance
Kim McCleary, Director of Strategic Initiatives, FasterCures
John F P Bridges, Ph.D., Associate Professor, Johns Hopkins

Join The Conversation

10/29/14: What can be done across the health care community to best respond to infectious diseases like Ebola?

Back to Top

Contributors:

              
Paul Stoffels, M.D., Chief Scientific Officer, Johnson & Johnson
Donna Altenpohl, Vice President of Public Policy, GlaxoSmithKline
Andrew MacCalla, Director of International Programs and Emergency Response, Direct Relief
Erin Mullen, Executive Director, Rx Response
Dr. William "Bill" Chin, M.D., Chief Medical Officer and EVP, PhRMA
Mark Mosely, VP of Global Essential Medicines, Supplies and Services , Map International
John P. Howe III, M.D., President and CEO, Project HOPE

Join The Conversation

Pages