What Are the Six Protected Classes of Drugs Covered By Medicare?
- Every Medicare Part D plan is required to cover certain protected classes of drugs. Learn more about which prescriptions are protected under this requirement.
There are six protected classes of drugs covered by Medicare Part D prescription drug plans. Regardless of which Medicare Part D provider you have, every plan is required by the Department of Health and Human Services to cover these six protected classes.
This federal rule helps ensure quality of care to all older adults who are enrolled in Medicare.
What Are the Six Protected Classes of Drugs?
The six protected classes of drugs include the following:
- Anticonvulsants: Primarily used to treat epileptic seizures but sometimes used to treat bipolar disorder and borderline personality disorders
- Antidepressants: Treat depression, anxiety disorders and certain chronic pain conditions and can be used to manage substance abuse issues
- Antineoplastics: Treat cancer, arthritis and multiple sclerosis, among other conditions
- Antipsychotics: Often used to treat bipolar disorder but can be prescribed for other mental illnesses
- Antiretrovirals: Used to treat HIV and hepatitis
- Immunosuppressants: Prescribed to treat many conditions, including Crohn’s disease, rheumatoid arthritis and multiple sclerosis, and used in nearly all organ transplant cases
Which Drugs in the Six Protected Classes Are Covered?
While every Medicare Plan D provider is required to cover drugs in the six protected classes, the exact drugs that each provider covers varies. The list of drugs that each Medicare Plan D provider covers is called a formulary, and every insurer's formulary is different.
The one thing that every Medicare Plan D plan has in common is that, by law, its formulary must cover two drugs in each of the six protected classes. Each formulary also covers both generic and name brand drugs.
While Medicare Plan D providers can change the list of drugs they offer in the six protected classes at any time, they must notify enrollees when they do so.
Didn't the Federal Government Change the Rule on Protected Classes of Drugs in 2021?
You may have concerns over having seen or heard news about the federal government giving Medicare Part D providers the option to drop coverage of certain protected classes of drugs.
The rule change was announced on January 19, 2021, and would allow Medicare Part D providers to stop covering certain drugs in five of the six classes protected starting in 2022. However, this proposed rule was struck down before it took effect, ensuring that every Medicare Part D provider is still required to cover the whole range of drugs in the six protected classes of drugs.