We’re Escalating the Step Therapy Fight

Policymakers are paying attention to our call to resume a ban on step therapy for Part B drugs in Medicare Advantage plans. The Academy met with the Department of Health and Human Services this week, including the department’s chief of staff.

We know step therapy has been a major member concern — especially as more patients choose Medicare Advantage over traditional Medicare fee-for-service.

During the meeting, agency officials were sympathetic to our position but said they need to see more data before issuing a rule. They asked the Academy to follow up with data points and studies that could be used to show disparate outcomes attributable to step therapy requirements. We are working to gather research and will keep you informed.

How You Can Help

If you can help us develop these data points or if you have a story of how step therapy has hurt your patients, email healthpolicy@aao.org. Your involvement is the most powerful tool in our ongoing calls for reform.

Background on Step Therapy in Medicare Advantage

The Centers for Medicare & Medicaid Services (CMS) rescinded a 2012 ban on the practice in 2019. Since the change, the Academy has asked the agency to reinstate the ban multiple times. This year alone, we’ve built a coalition with 79 patient and provider groups and sent letters to CMS Administrator Chiquita Brooks-LaSure. We also met with CMS in May with representatives of these physician and patient advocacy organizations to tell patients’ stories.

After no progress from that meeting, the Academy elevated the pressure with a meeting with staff for Xavier Becerra, the secretary of Health and Human Services. We used the opportunity to share how the policy delays medically necessary treatment and may result in patient harm.

The policy may also exacerbate health disparities because fee-for-service Medicare does not have step therapy requirements. Medicare Advantage patients are disproportionately lower-income, Black or Latino compared with fee-for-service patients.