AMCP CEO Blog: By now, it’s virtually an article of faith that the costs of pharmaceuticals are too high (and, by-the-way, so are costs of hospitalizations, MRIs, ambulance rides and many other health care interventions).
On August 7, 2018, CMS issued guidance to Medicare Advantage (MA) plans acknowledging that step therapy is a recognized utilization management tool. CMS stated that the allowance of step therapy practices for Part B drugs will help achieve the goal of lower drug prices while maintaining access to covered services and drugs for beneficiaries. MA plans will have the choice of implementing step therapy to manage Part B drugs, beginning January 1, 2019.