Academy Urges CMS to Address Prior Authorization, Other Burdens in Medicare Advantage Plans

The Academy used a recent call for input on improvements to the Medicare Advantage Program to reiterate our concerns about administrative burdens. In comments submitted to the Centers for Medicare & Medicaid Services (CMS), we urged the agency to increase oversight of plans and reinstate a ban on step therapy.

CMS recently sought public comment on ways to improve the Medicare Advantage program. The agency wanted input on several goals:

• Improve health equity, given growing awareness of disparities among Medicare patients.
• Expand access to care, especially for underserved communities.
• Encourage innovation to improve the quality of care provided.

CMS also sought input on how to improve its partner relationships and ensure Medicare Advantage remains affordable and sustainable.

The Academy focused on three issues in our comments: , step therapy and onerous record requests. We noted the many issues caused by Aetna’s albeit short-lived .

We also highlighted the growing disparities caused in 2019 when CMS allowed step therapy to return to Medicare Advantage plans for Part B medications. This policy delays care for Medicare Advantage and harms seriously ill patients. Compared with fee-for-service patients, they are disproportionately lower-income, Black or Latino and more often dually enrolled in Medicaid.

We urged CMS to reinstate its previous ban on step therapy, to ensure all Medicare patients get equal and timely access to the treatments they need.

Lastly, the Academy urged CMS to address burdensome record requests to medical practices. These requests often fail to clarify or address insurers’ underlying goals, and they may also contribute to dubious billing practices by Medicare Advantage plans.

We will continue to use every opportunity to address the administrative burdens you face and the ways they delay patients’ timely access to medically necessary treatment.