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Step Therapy: Why Fail First for Everyone is Not a Good Idea
By: Corey Greenblatt
Physicians may endorse step therapy for medical reasons but when it is used solely to save the system money, it can harm people with chronic illnesses.
The final rule that would allow Part B Medicare Advantage health plans to implement step therapy and other drug-limiting programs was announced by the Center for Medicare & Medicaid Services (CMS) on May 16, 2019. You can read about it this press release entitled “CMS empowers patients with more choices and takes action to lower drug price.” This rule is part of the Trump Administration’s plan to lower drug prices by introducing more negotiation and competition.
The problem is that these “fail first” programs will adversely affect people with arthritis and other chronic illnesses. Here’s why.
What are Part B medications?
Part B medications are treatments that need to be administered in a provider’s office or in a hospital setting. Patients with rheumatoid arthritis and other autoimmune diseases, as well as many other chronic disorders, are often forced to use medications covered under Medicare Part B. This is because of the complexity and progression of their disease on other types of treatments.
