Advocacy News

UnitedHealthcare and Humana responded to our Oct. 31 letters alerting payers of access issues for compounded Avastin. Practices should note the national shortage when requesting prior authorization for another drug.

CMS signaled a willingness to review the request in its Nov. 12 meeting with the Academy and the American Society of Retina Specialists.

Practices can note access issues in precertification requests to be granted an exemption from step therapy requirements. 

The Academy has focused on reducing drug waste and promoting patient and physician access to ophthalmic drugs.

Bipartisan House and Senate legislation would take proactive steps to address the root causes of an increasingly broken pharmaceutical supply chain.

CMS has told Medicare Advantage plans that the two biosimilars, which are not clinically proven to treat eye disease and are potentially dangerous to ophthalmology patients, may not be used as substitutes for Avastin or be required in their step therapy programs.

As concern grows about Avastin shortages, the Academy and the American Society of Retina Specialists this week are pushing health plans to halt step therapy and prior authorization requirements imposed on alternative therapies to avoid further patient care disruption.