AMA leads nearly 100 medical groups calling on CMS to rethink step therapy for Part B drugs

AMA and dozens of state and national provider organizations say CMS' step therapy changes will create "unnecessary complications" for patients. (Getty/bee32)

Nearly 100 state and national provider groups are calling on the Trump administration to reconsider a recent rule change to allow Medicare Advantage plans to use step therapy for Part B drugs beginning next year. 

Led by the American Medical Association, 44 national medical associations argued that the use of step therapy was particularly dangerous for physician-administered drugs covered under Part B, which are often provided to patients with serious or life-threatening conditions. The organizations urged the Centers for Medicare & Medicaid Service (CMS) to reinstate a 2012 policy that barred Medicare Advantage plans from using step therapy on Part B drugs. 

In a letter to Administrator Seema Verma obtained by FierceHealthcare, the AMA and dozens of specialty groups said the agency's recent policy change would lead to delays in appropriate treatment and "unnecessary complications in the physician-patient decision-making process."

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RELATED: CMS allows Medicare Advantage plans to negotiate Part B drug prices, implement step therapy

CMS announced the change in July, arguing that step therapy would allow MA plans to reduce Part B drug costs. Step therapy is a form of prior authorization that requires patients to try "preferred" lower cost biosimilar drugs before escalating to higher cost branded medications. The policy, which takes effect in 2019, would only apply to new prescriptions and insurers would pass half of the savings to members.

RELATED: UnitedHealthcare and AMA clash over Medicare's step therapy changes

"We find the growing trend towards the use of restrictive and burdensome utilization management tactics by payors concerning and urge CMS to reconsider its stance on this critical patient care issue," they wrote. 

Read the full letter below: 

 

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