• Academy Discusses Controversial Step-Therapy Proposal with HHS Secretary

    The Academy met with U.S. Department of Health and Human Services Secretary Alex Azar Wednesday, urging the Trump administration to carefully consider the potential effects of its intended expansion of drug step therapy to Medicare Advantage. 

    The meeting, held at Secretary Azar’s request, follows last week’s announcement that the Centers for Medicare & Medicaid Services would allow step therapy in Medicare Advantage for physician-administered drugs. 

    We expressed how our ongoing issues with Medicare Advantage plans’ current use of prior authorization gives us little confidence that they would fairly administer a program that could deny our patients of medically necessary treatments. 

    The Academy immediately expressed deep consternation of this plan after CMS’ announcement last week. We believe it is a legally questionable policy with a potentially dangerous effect in eye care. It would remove physicians’ and patients’ treatment choices from care, while possibly pitting us against health plan representatives who would make the final say on treatment. 

    The Academy was represented by David B. Glasser, MD, our secretary for federal affairs, and Cathy G. Cohen, vice president of government affairs. We were joined in the meeting by the American Cancer Society’s Cancer Action Network, the American College of Rheumatology, the American Society of Clinical Oncologists and Patients for Affordable Drugs, each of whom also expressed reservations with CMS’ plan after its announcement. 

    Among the issues the Academy raised was the urgency involved in treating some patients. We shared how delays in care for some retinal diseases can result in permanent vision decreases. 

    Azar appeared receptive to additional patient protections. One in particular would be for patients changing plans whose treatment using the new plan’s preferred therapy already failed. 

    Azar also shares the Academy’s belief that few plans have the ability adopt and implement step therapy in time for 2019 enrollment. That would push this issue into 2020 at the earliest.