Advocacy & Practice Updates — Advocacy & Practice
ASRS Reminds Insurers That CMS has Encouraged Suspending Step Therapy During Avastin Shortage
Along with reminding them that the recent CMS memo asks plans to hold off on step therapy, ASRS has requested meetings with Florida Blue Cross and Independence Blue which require or, are planning to require, step therapy for anti-VEGF drugs.
- Florida Blue's November announcement directed practices to obtain Avastin from specific repackaging facilities along with re-emphasizing its step therapy requirements. ASRS continues to hear that the logistics of switching to new repackaging facilities is not without its problems. Even after signing up, the supply is not available. This problem is exacerbated when step therapy is required. In the ASRS letter, we ask that the plan suspend its policy and meet with us to further discuss access issues.
- In the ASRS letter to Independence Blue, we explain that patients are impacted by rigid step therapy guidelines that unnecessarily delay treatment. Physicians and patients should be making decisions about the course of therapy that works best for the patient medically and financially. Independence Blue's plan to rely on formularies that include biosimilars and place limits on first- and second-generation anti-VEGFs are failing to do what is best for patients in order to save their vision, and we ask that their policy be reversed.
If you are having difficulties with commercial insurers or Medicare Advantage plans, please contact ASRS Director of Practice Management, Monica Horton.
(Published 12.17.24)