Advocacy & Practice Updates — Advocacy & Practice
ASRS, AAO Call on CMS to Suspend Avastin-First Step Therapy Policies; Caremark/Aetna Requests Shortage Notation on Authorization Forms
ASRS, AAO Call on CMS to Suspend Avastin-First Step Therapy Policies; CVS Caremark/Aetna Requests Shortage Notation on Authorization Forms
This morning, ASRS and AAO sent a joint letter to CMS recommending the agency direct Medicare Advantage (MA) plans to suspend Avastin-first step therapy policies and relax prior authorization requirements in light of the recent news that Pine Pharmaceuticals is ceasing repackaging of Avastin. The letter outlines the ongoing supply chain issues for repackaged Avastin that have burdened retina practices and patients for several years and notes that this particular issue is unlikely to be resolved in the near term.
This joint letter to CMS is in addition to ASRS letters to national insurers Aetna, United, Cigna, Blue Cross and Blue Shield Association (BCBSA), Elevance, Humana, Medical Care Services (MCS) and Triple S Blue Cross, to request they discontinue step therapy.
In response to our outreach, CVS Caremark and Aetna said they are aware of the impending shortage and will follow the medication shortage processes outlined on their website. Please be sure to note that you are unable to obtain Avastin on your prior authorization forms.
As we receive responses to our request, ASRS will provide updates on how to proceed.
A list of FDA Registered Outsourcing Facilities can be found here: https://www.fda.gov/drugs/human-drug-compounding/registered-outsourcing-facilities. Please contact Monica.Horton@asrs.org if you have specific questions.
(Published 10.16.24)