SWHR Expresses Concerns Regarding CMS Step Therapy Proposal

Policy Engagement

Published 10/5/18

SWHR sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma expressing concerns regarding a recent CMS step therapy proposal. The proposal in question would allow Medicare Advantage (MA) plans to implement step therapy in the management of Part B-covered medications. CMS announcement of this new direction came as a surprise, with no opportunity for public comment specified prior to the policy going into effect on January 1, 2019.

Women constitute more than half of the individuals within the Medicare program, and this population of older women comparatively experiences more chronic health difficulties than their male counterparts. The new CMS step therapy proposal would interfere with continuity of care for MA patients, provide insufficient time for exceptions and appeals, and would likely subject seniors to higher out-of-pocket costs. SWHR encouraged CMS to issue updated oversight and safeguard requirements for this new policy in order to prevent increased burden for patients receiving care under MA plans.

Read SWHR’S Full Letter Here

SWHR’s letter was cited in the Biotechnology Innovation Organization (BIO) blog post, Watchdog Report Reaffirms Concerns With Fail First.