In a letter to the Secretary of the Department of Health and Human Services Alex Azar, we strongly urge the Administration to accompany the policy allowing Medicare Advantage (MA) plans to use step therapy with a set of patient protections including:
- Adherence to evidence-based treatment guidelines: Guidelines must be put in place to require step therapy protocols to follow clinical practice guidelines and best practices that have been vetted through the peer review process.
- Protection for mid-treatment patients: We support the approach to ensure patients who are currently using medication that has already been proven to work effectively would not have to change medications.
- Recognized standard of care: There must be a requirement to start step therapy with the recognized standard of care – even if that recognized standard is not the least expensive drug.
- A simple and expeditious exceptions and appeals process: Treatment for patients who need a drug higher in the step protocol should not be delayed by a lengthy appeals process.
- Full transparency and oversight: Medicare beneficiaries should know in advance of enrolling in a health insurance plan whether there is a restrictive step therapy clause.
We partnered with ACS CAN on the letter and nearly 90 organizations added their name of support.