The Weekly Roundup: Next Steps for Step Therapy (5.31.19)

May 31, 2019 | Pamela Youngberg

On May 17, CMS announced its final rule on Medicare Part D and Medicare Advantage plans with a range of measures seeking greater transparency and negotiating power. The proposed rule had excited extensive comment from healthcare providers and patient advocacy groups on one aspect of the rule: that Medicare Advantage plans will allow the use of “utilization management tools, such as step therapy, for Part B drugs,” which CMS believes will enhance the ability of Medicare A plans to negotiate Part B drug costs. Not so fast, say many healthcare providers who want to put legislative guardrails around the practice of step therapy and thereby put “patients and doctors back in charge of healthcare.” Groups like the Arthritis Foundation were vocal supporters last month at the introduction by Reps. Raul Ruiz (D-CA) and Brad Wenstrup (R-OH)—both doctors—of H.R. 2279, The Safe Step Act. The federal legislation would require the establishment of a clear process for exceptions and impose time limits on insurer approval, and it mirrors many similar efforts at the state level. The National Psoriasis Foundation maintains a convenient map of activity in each state.

Here are a few other stories that might be of interest:

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Pamela Youngberg

Before she came to Smart-Fill, Pamela developed marketing strategy and content for a range of technology start-ups and large-cap enterprises. Outside the office, she's into cycling, renaissance history, cooking, and exploring the outdoors in the beautiful Pacific Northwest.

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