Advocacy & Practice Updates — Clinical Updates

ASRS Recommends CMS Reinstate the Ban on Step Therapy in MA

This week, ASRS submitted comments to CMS in response to a request for information on how to improve the Medicare Advantage (MA) program. Chief among our recommendations is to reinstate the previous ban on step therapy in MA. ASRS argues that by allowing plans to implement step therapy policies, CMS has created an inequitable system preventing MA beneficiaries from accessing the same treatments they would have had they been covered under original Medicare. ASRS also noted that step therapy and prior authorization burdens fall more heavily on patient populations that already experience systemic inequities. These patients may not receive early screening for retinal disease or may have difficulty accessing care, and so delays when they visit a retina specialist may lead to poorer outcomes. In addition, we suggest other beneficiary protections CMS could implement. 
(August 31, 2022)