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On April 22, the American Society of Anesthesiologists (ASA) joined a coalition of health care organizations in urging the Department of Health and Human Services Secretary Xavier Becerra to reinstate the step therapy prohibition in Medicare Advantage plans for Part B drugs, which include drugs used to treat a wide variety of chronic conditions, including chronic pain.
ASA believes that beneficiaries enrolled in Medicare Advantage plans should continue to have appropriate and timely access to the therapies they need to properly manage their conditions. In 2018, the Centers for Medicare and Medicaid Services (CMS) rescinded the prohibition on mandatory step therapy and issued a new guidance allowing Medicare Advantage plans to use step therapy for Part B drugs. ASA remains opposed to the removal of this important patient protection. Step therapy is utilized by health plans to determine coverage and requires that patients fail on an insurers’ preferred medication before the prescribed therapy is covered. This results in frequent delays or disruptions in the continuity of care and threatens outcomes for patients. For ASA members, pain medicine specialists have voiced that step therapy policies can be administratively burdensome on physicians and their staff, and interfere with the patient – physician relationship, resulting in delayed treatment and in some cases irreversible disease progression. ASA member David Walega, MD, testified before the US House of Representatives Committee on Small Business last year on the needless and harmful delays that step therapy has had on his patients. ASA believes physicians are in the best position to assess their patients’ medical needs.
ASA looks forward to continuing working with CMS and stakeholder organizations to improve patient outcomes and urges Secretary Becerra to immediately reverse the harmful decision allowing step therapy. ASA also encourages CMS to continue its work with patients, physicians, and other key stakeholders to develop solutions that will ensure Medicare beneficiaries continue to have timely and affordable access to the life-saving clinical treatments they need.
