PBM Practices Such as Prior Authorization and Step Therapy Harm People With Cancer, ASCO Tells Senate Committee

April 11, 2019

ASCO submitted its position statement on the impact that Pharmacy Benefit Managers (PBMs) have on cancer care to a U.S. Senate Finance Committee hearing, “Drug Pricing in America: A Prescription for Change, Part III.” PBM representatives testified in-person during the hearing, which was held as part of Congress’ ongoing efforts to address rising prescription drug costs in the United States. In its submission, ASCO reiterated the society’s concerns about the negative effects of certain PBM practices on patients and the cancer care system.  

ASCO has heard serious concerns from its members about PBM practices that are harming people with cancer. Members have reported PMB errors in filling prescriptions, treatment doses being altered without consulting oncology care providers, duplicate patient copays due to incomplete dispensing, and drug waste resulting from incorrect doses or treatments being sent directly to a patients’ homes.

ASCO members have also expressed frustration due to the utilization management techniques that PBMs employ to control the use of cancer therapies. Prior authorization and step therapy, in particular, can delay access to appropriate cancer care, lead to irreversible disease progression, alter the ability of preferred treatments to achieve their desired effect, and introduce other significant patient health risks. For these reasons ASCO applauds introduction of H.R. 2279, “The Safe Step Act,” which would put protections in place to help patients access potentially lifesaving medications in a timely manner.

ASCO remains committed to the principles and recommendations conveyed in its 2017 policy statement on utilization management, and to working with stakeholder groups to develop and implement policies that benefit patients with cancer.

Visit ASCO in Action for updates on federal efforts to address drug costs and all the latest cancer policy news.