The Weekly Roundup: Next Steps for Step Therapy (5.31.19)
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:
- Keeping busy? According to the National Health and Nutrition Examination Survey, nearly one-half of the U.S. population has used prescription drugs in the previous 30 days.
- Proposed California bill would allow a 30-day supply of Truvada without a prescription, requiring pharmacists’ counseling on the risks.
- The FDA held its first public hearing Friday to assess the safety and efficacy of CBD.
- Doing double duty. Trials tracking statins have also demonstrated a significantly decreased risk of primary open-angle glaucoma (POAG).
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