DHPA joined a coalition of 240 patient and provider groups signing onto a letter to U.S. Senate and U.S. House leaders asking them to urge the Centers for Medicare & Medicaid Services (CMS) to reconsider a proposal to allow Medicare Advantage plans to implement step therapy to manage Part B drugs. CMS originally announced the proposal in August in a memo to Medicare Advantage plan sponsors.
Step therapy, sometimes known as “fail first,” is a process employed by insurers that forces patients to try therapies preferred by the insurance company before being approved for the therapy their doctor prescribed — even when doctors doubt the insurer preferred option will be effective.
The coalition writes in the letter, “Our concerns grow from the direct negative experiences that many of our organizations’ members have had with step therapy. As a result of insurers’ step therapy (also known as “fail first”) policies in the commercial market, patients have experienced delayed and restricted access to needed treatments which can impact quality of care, while physicians have experienced significantly increased administrative burdens. At a time when policymakers are seeking reforms that empower and engage patients, and reduce needless provider burden, the CMS guidance is a step in the wrong direction for Medicare and seniors.”
Click here to read the full letter.