Advocacy & Practice Updates — Advocacy & Practice
ASRS Recommends CMS Finalize and Expand on MA Prior Authorization Proposals
Late last week, ASRS submitted comments on the 2024 Medicare Advantage (MA) and Part D proposed rule. Following years of advocacy by ASRS and others in the medical community, CMS included significant policy proposals in this proposed rule aimed at ensuring MA plans do not use prior authorization to deny medically-necessary care that would have been covered under original Medicare. These proposals also seek to address recommendations by the HHS Office of Inspector General (OIG) in a report that found MA plans routinely use prior authorization to deny medically-necessary services.
In our comments, ASRS thanks CMS and recommends it finalize proposals to help ensure beneficiaries have access to medically-necessary care and issued support for other proposals such as a requirement that MA plans create utilization management review committees. In addition, we strongly urge CMS to eliminate plans’ ability to use step therapy for Part B drugs because it denies beneficiaries access to treatments that would be covered under original Medicare. We also recommend CMS take additional steps to curb plans’ use of prior authorization and cite a recent study sponsored by ASRS, which found that more than 97% of prior authorization requests for intravitreal injections are ultimately approved.
ASRS also joined in comments on the proposed rule with the Alliance of Specialty Medicine, the AMA, and the step therapy coalition. A final rule should be released later this spring.
Published February 15, 2023