CMS Gives MA Plans New Part B and D Drug Flexibilities

In a memorandum to Medicare Advantage organizations, the Centers for Medicare & Medicaid Services yesterday announced new flexibility related to the use of step therapy in coverage of Part B services. The agency will allow MA plans to impose step therapy requirements for covered Part B drugs beginning in the 2019 plan year. In addition, the agency will permit those plans that also provide Part D coverage to require that a beneficiary try a Part D drug therapy prior to covering a Part B drug therapy. Federal law allows plans to use some utilization management tools, such as prior authorization; however, the agency has previously not allowed the use of step therapy, nor plans to manage coverage across the Part B and D benefits. The agency will require any plans that take advantage of this new flexibility to provide notice to beneficiaries, as well as additional care coordination services to support access to care. For more see the CMS factsheet.