Doctors Caucus Urges Agencies to Reconsider Step Therapy

July 23, 2019

In early July 2019, 14 out of the 16 members of the House GOP Doctors Caucus sent a letter to Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma requesting that their agencies reconsider a policy allowing Medicare Advantage plans to use step therapy.

Step therapy requires patients to try and fail to have a desired clinical outcome on a lower-cost medication before they can access the medication prescribed by their health care provider. ASCO opposes the use of step therapy in cancer care, citing delays in patient access to the right treatment for their specific diagnosis, which can potentially lead to irreversible disease progression and other significant health risks.

The letter echoes ASCO’s opposition, saying that: “Given its potential negative impact on patient health and safety outcomes, we believe the Department of Health and Human Services (HHS) and CMS should reconsider its step therapy policy for Medicare Advantage plans and work with Congress, patients, providers, and other key stakeholders to develop alternative solutions that would ensure Medicare beneficiaries continue to have timely access to the critical treatments they need, while lowering the cost of medications for patients and the Medicare program.”

Though some key protections for Medicare beneficiaries were maintained in the Medicare Advantage and Part D drug pricing final rule, concerns remain that some of the most vulnerable patients remain at risk under Part B’s step therapy practices.

ASCO worked with Rep. Andy Harris, MD (R-MD-01) to gain support for the letter and will continue to oppose step therapy practices on Capitol Hill.

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