If you’re off this week, excellent timing. I feel like things were sort of quiet. Or maybe that is just compared to last week.

Caught my Eye

Work It. I had a long post I was starting to write about health insurance in America and then I saw this NYT article and just stopped; Sarah Kliff got most of the points I was going to make. It explores the tie of work and health insurance and the relatively new question, is health insurance essential? Note that the reason that I could start my own consulting business is that my husband has health insurance that will cover me. On my own? Could have been the big barrier.

Spiked. Affordable Care Act Premiums expected to increase about 18% according to work done by KFF because of rising costs, tariffs, labor costs, GLP-1s and specialty meds, uncertainty about exchange subsidies, etc.

In Case You Missed It. One of the impacts of the One Big Beautiful Bill is that Keytruda and Opdivo won’t be eligible for negotiation until 2029 (were expected in 2028). And that’s if a biosimilar doesn’t enter earlier.

And a court has put an Arkansas law barring pharmacy benefit managers from also owning pharmacies in the state in a holding pattern. The law was set to begin on January 1.

Reviewing the Fundamentals – Part D’s Six Protected Classes

In the Medicare Part D program, the Centers for Medicare & Medicaid Services (CMS) has designated six drug categories “classes of clinical concern”, more commonly known as the six protected  classes. These conditions often require a variety of treatment options because patients can respond differently to medications, and interruptions in therapy can be dangerous. The six classes are:

• Antineoplastics (cancer drugs)
• Antiretrovirals (HIV/AIDS drugs)
• Antidepressants (for depression and mood disorders)
• Antipsychotics (for psychotic disorders)
• Anticonvulsants (for epilepsy and seizures)
• Immunosuppressants (for organ transplant recipients)

Part D plans must cover “all or substantially all” of the drugs within them. This differs from other drug categories, where plans are only required to cover a minimum of two drugs. The protections are not absolute; plans can still prior authorization and step therapy.

These restrictions can be applied to new patients in five of the six classes (all except antiretrovirals). They cannot be applied to a patient who is already stable on medication, nor can they be used for antiretrovirals.

For the Files

These Health Affair briefs can be helpful when you’re diving into something new.