Medicare provides health insurance for Americans age 65 and older, and to younger people with disabilities. More than 570,000 adults age 65 and older live with epilepsy, and that number is rising rapidly as the baby boomer generation enters retirement age. Additionally, many individuals under age 65 living with epilepsy are Medicare beneficiaries due to their disability status. The Medicare program is comprised of four parts:
- Medicare Part A covers hospital care and other skilled non-routine care, including nursing home and skilled nursing care, hospice care, and home health services.
- Medicare Part B covers medically necessary and preventative services, including care to diagnose or treat a condition.
- Medicare Part C (Medicare Advantage) plans offer Part A, Part B, and Part D (described below) benefits in one plan
- Medicare Part D covers many prescription drugs,
Medicare Part D & the Six Protected Classes
The Epilepsy Foundation strongly supports Medicare Part D’s Six Protected Classes policy which ensures greater protections for six classes of medications, including anticonvulsants for epilepsy. Epilepsy medications are not interchangeable, and beneficiaries often react quite differently to the available treatments. People living with epilepsy need meaningful access to the full range of therapies available, and the specialists who know how to prescribe them. When people living with epilepsy are forced to switch medications, or alter their treatment plan, it can lead to breakthrough seizures, associated complications and costs, or even death.
Despite the intent of the Six Protected Classes policy, Medicare Part D beneficiaries living with epilepsy confront barriers to care due to utilization management activities, including high cost-sharing, that limit access to lifesaving epilepsy medications. A 2013 study by Avalere Health found that Medicare Part D plans provide lower levels of coverage for anticonvulsants than commercial health insurance plans.
Learn more about our advocacy efforts to preserve the Six Protected Classes
Medicare Part D Low-Income Subsidy (LIS) or Extra Help Program
The Epilepsy Foundation strongly supports the Medicare Part D Low-Income Subsidy (LIS) or Extra Help program, which helps low-income Medicare beneficiaries afford prescription medications. More than 11 million Medicare beneficiaries rely on this program to access needed medications, including more than 6 million that are dual eligible for both Medicare and Medicaid. Unfortunately, some in Congress, as well as the Medicare Payment Advisory Commission (MedPAC), have proposed changes, including decreasing subsidies for brand medicines used by LIS and dual eligible beneficiaries in the hopes of cutting costs. If implemented, these changes would place the most vulnerable enrollees in the Part D program at great risk. Read the coalition letter below urging support for the program below.
2017 Patient Groups LIS letter (Oct 2 2017)