Advocacy & Practice Updates — Advocacy & Practice
ASRS Continues Efforts to Ensure Retina Specialists' Choice of Medication
ASRS continues to fight tiered therapy policies on behalf of its members.
Most recently, ASRS assisted Iowa members in convincing Wellmark Blue Cross Blue Shield of Iowa to not implement a draft policy that would have required prior approval for Lucentis and Eylea, but not Avastin, as well as a post-medical necessity review for the two US Food and Drug Administration (FDA)-approved drugs.
ASRS has also sent letters on behalf of Kentucky members to Avesis (a third-party payer that covers all eye care for Kentucky Medicaid Managed Care companies) and on behalf of Michigan members to Blue Care Network of Michigan opposing their respective tiered therapy policies.
Finally, to combat perhaps the most egregious example of third-party payer misconduct, ASRS is opposing a new CVS/Caremark policy on behalf of SilverScript that calls for replacing Lucentis with interferon, after being contacted by a Pennsylvania member. A temporary fix is already in place, and we believe that based on our strong letter this misguided policy will be permanently fixed.
Please contact Jill Blim immediately if any of your insurers are restricting your choice of medication. The ASRS leadership stands ready to assist you.
Published March 2014