Advocacy & Practice Updates — Advocacy & Practice
OIG to Examine MA Prior Authorization and Step Therapy for Part B Drugs
Following advocacy from ASRS and AAO, the HHS Office of Inspector General (OIG) has announced a new study examining Medicare Advantage (MA) plans’ use of prior authorization and step therapy for Part B drugs. The review will assess whether MA plans are complying with program requirements, following clinical guidelines, and avoiding unnecessary delays that could negatively affect patient outcomes.
ASRS and AAO have been pushing for an OIG study on step therapy since release of the agency’s 2022 examination of MA prior authorization, which identified concerns about inappropriate denials and led to increased CMS oversight and new requirements for MA plans. In requesting a similar study, our organizations have pointed out MA plans’ tendencies to require ineffective treatments, interfere with the doctor-patient relationship, and generally delay or deny care that would otherwise be covered under original Medicare. We will keep you updated as the study progresses.
(Published 9.22.26)