On August 7, the Center for Medicare and Medicaid Services (CMS) issued guidance giving Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs, effective January 1, 2019. Step therapy means trying less expensive options before "stepping up" to drugs that cost more.
A statement from American Cancer Society Cancer Action Network (ACS CAN) President Chris Hansen follows:
"ACS CAN shares the administration's goal of lowering prescription drug costs for patients. However, the details of the policy change to allow for step therapy will be important to understand the impact on cancer patient access to lifesaving therapies.
"In some instances, utilization management tools like step therapy can create an extra hurdle for cancer patients to go through before getting the appropriate drug they need to treat their cancer. Some patients may be required to try multiple therapies before they can access the one that was prescribed by their doctor.
"It is imperative that any step-therapy process be accompanied by a speedy and easily understood appeals process to ensure patients don't face delays to recommended treatment that could compromise the efficacy of those therapies in treating their cancer. We are pleased CMS intends to allow beneficiaries access to an appeals and exceptions process and urge them to closely monitor the extent to which beneficiaries are seeking exemptions and appeals.
"Going through cancer treatment is hard enough – cancer patients should not be forced to "fail first" on a drug that is known not to work for them before they are allowed to take the recommended treatment."