CMA calls on CMS to reverse step therapy decision

September 14, 2018
Area(s) of Interest: Advocacy 

The California Medical Association (CMA) and an American Medical Association (AMA)-led coalition of 94 medical societies delivered a letter to the Centers for Medicare and Medicaid Services (CMS) about the serious concerns physicians have with the agency’s recent decision to allow Medicare Advantage plans to use step therapy for Part B drugs.  The letter calls on CMS to reinstate its 2012 policy prohibiting Medicare Advantage plans from utilizing step therapy protocols for Part B physician administered medications.

The growing burdens generated by step therapy and prior authorization programs create a lengthy process of red tape, multiple phone calls and bureaucratic battles that delay and disrupt patient access to care.

“Step therapy protocols that require patients to try and fail certain treatments before allowing access to other, potentially more appropriate treatments can both harm patients and undercut the physician-patient decision-making process,” the coalition wrote in a letter to CMS Administration Seema Verna, M.D. “The most appropriate course of treatment for a given medical condition depends on the patient’s unique clinical situation and the care plan developed by the physician in close consultation with that patient.”

While CMA and AMA recognize the huge financial burdens on patients and the health care system caused by rising drug prices, it is our hope that another layer of administrative complication will not be added on to an already strained system.

“We recognize the significant difficulty of finding meaningful solutions that have the desired outcome of reducing costs for both,” the letter said. “However, as we work towards finding policies to address this problem, we hope that solutions can be found that do not involve the creation of barriers to appropriate and timely treatment for some of our most critical patients.”


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