CMS: Medicare Advantage Plans Can Require Step Therapy (Insurers can impose this form of prior authorization for Part B drugs next year)
Medpage: The Centers for Medicare and Medicaid Services (CMS) will allow Medicare Advantage plans in 2019 to apply a "step therapy" approach to Part B drugs.
CMS made the announcement and issued a memo detailing the changes on Tuesday afternoon. There's just one problem. Step therapy is a form of prior authorization and physicians really, really hate prior authorization, viewing it as disrupting the patient-physician relationship and creating an unnecessary burden.
In step therapy, patients must attempt another similar but typically less expensive medication before they can be prescribed a pricier one.
CMS Administrator Seema Verma told reporters on a conference call that the new approach would "ensur[e] that patients receive the most preferred drug therapy first."
The new option for plans would also create a "level playing field" between Part B and Part D drugs, enabling plans to negotiate better deals for patients, she added.
Part B drugs are typically more expensive and often include biologic agents. They are typically administered by physicians in their office, whereas Part D drugs are those picked up at a pharmacy and self-administered.
Full article here.