Advocacy & Practice Updates — Advocacy & Practice

ASRS Opposes Tiered Therapy Policies

At the request of members, the ASRS is actively opposing the tiered therapy policy instituted by Avesis, a third-party administrator that covers all eye care for Kentucky Medicaid Managed Care companies (CoventryCares of Kentucky, Kentucky Spirit Health Plan, and WellCare of Kentucky), as well as a draft policy issued by Wellmark Blue Cross and Blue Shield of Iowa. 

The ASRS believes it is inappropriate for any insurer to require the off-label use of Avastin  before the use of two available US Food and Drug Administration (FDA)-approved agents (Lucentis and Eylea) is considered.

ASRS strongly urges insurers to continue to allow retina specialists and their patients to make wise and judicious choices based on the patient’s unique risk factors, clinical appearance, availability of compounded drugs, and economic requirements. Artificially imposed practice modifications for nonmedical, financial reasons is inappropriate and will continue to be actively opposed by the ASRS on a national and international level, working with local retina specialists.

Please contact Jill Blim if you have any evidence that an insurance plan has a tiered therapy policy or is restricting beneficiaries’ access to Part B drugs or services.

Published February 2014