The Centers for Medicare and Medicaid Services (CMS) has announced that it is rescinding guidance issued in September 2012 that prohibited Medicare Advantage (MA) plans from using step therapy for Medicare Part B drugs.
Starting Jan. 1, 2019, MA plans will have the option of implementing step therapy to manage Part B drugs. Step therapy is a type of prior authorization for drugs that begins with the most preferred drug therapy for a medical condition and then progresses to other therapies only when necessary.
Physicians and practices should be aware that ongoing Part B drug therapies will not be affected by the new requirements. Step therapy can only be applied to new prescriptions or administrations of Part B drugs for beneficiaries that are not actively receiving the affected medication. CMS says that no beneficiary receiving drugs under Part B will have to change their medication.
Other noteworthy provisions in the policy include:
CMS offers more details on the policy in this letter from CMS to MA Organizations.
Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.
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