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Advocates Take to Capitol Hill, Brief Lawmakers on the Harm of Step Therapy


Advocates took to Capitol Hill last week to brief lawmakers and their staff about the implications the recent CMS policy change may have on patient access to treatments.

Last month, CMS announced that it would begin to allow Medicare Advantage plans to implement step therapy as a negotiation tool for drug prices. The announcement was met with concern as various industry stakeholders, such as the Community Oncology Alliance, the American College of Rheumatology (ACR), and the American Society of Clinical Oncology, all spoke out against the change.

Hosted by the Part B Access for Seniors and Physicians (ASP) Coalition, advocates took to Capitol Hill last week to brief lawmakers and their staff about the implications the policy may have on patient access to treatments covered under the Medicare Part B program.

Read more about how seniors may be impacted by the Medicare policy change.

Providing the physician viewpoint of step therapy during the meeting was Angus Worthing, MD, FACP, FACR, a practicing rheumatologist and chair of the ACR’s government affairs committee. “Far too many of my patients with Medicare prescription drug plans have experienced frustrating delays in getting treatment due to step therapy,” he said. “Expanding step therapy to [Medicare Advantage] plans will only add more people to the list of those who will face difficulties assessing the care prescribed by their physician as the best course of care.”

Lawmakers also heard from Katie Roberts, a patient advocate with the Arthritis Foundation. “As an individual with psoriatic arthritis, I am unfortunately all too familiar with how even seemingly brief delays in treatment can make a crucial difference in a patient’s life… Lawmakers must understand that this policy change will do real harm to individuals with chronic diseases by delaying treatment access at a time when it is most critically needed.”

During the briefing, a representative from Xcenda, a policy research and consulting firm, provided an overview of their recent report that analyzed physicians’ prescribing behavior through the Medicare Part B program. The report, titled “Medicare Physician-Administered Drugs: Do Providers Choose Treatment Based on Payment Amount?” found that “there is no meaningful correlation between drug payment and utilization, challenging the theory that physicians significantly favor drugs with high add-on payments.”

Though many industry groups have spoken out against the policy change, CMS has remained firm in its decision. The policy change will take effect in January 2019.

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