Perspectives on Step Therapy for Part B Drugs
September 20, 2018
In a move that industry analysts see as a positive development for the managed care sector, CMS issued new guidance that will allow Medicare Advantage (MA) plans to use step therapy for Part B drugs starting in 2019, AIS Health reported.
CMS is giving MA plans that offer a Part D benefit the ability to “cross-manage” drugs across Part B and Part D. In other words, plans could require patients to try alternatives covered within Part D before moving on to relatively expensive physician-administered drugs in Part B,
Rice cautioned that with step therapy adoption optional for the 2019 plan year and a lack of clarity around formal rulemaking, shared savings arrangements and beneficiary adoption, “MA plans may be cautious in adopting step therapy.”