Beginning in January 2019, CMS will permit Medicare Advantage (MA) plans to use step therapy to control rising costs for Part B drugs, those administered in a doctor’s office. Physicians would be required to first try the least expensive drugs before moving on to their more expensive counterparts. This comes as a sharp departure from CMS’ 2012 guidance, which disallowed the practice in MA. Calling the practice the “failing first” model, many critics worry that it undermines doctors’ professional autonomy, decreases patients’ access and exposes them to unnecessary risk.

Also in Policy Brief:

  • Increasing Risk for MSSP Participants
  • Case Against the ACA Could Disrupt Kavanaugh’s Confirmation
  • Seema Verma Testifies in the Senate
  • AHPA Resources
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