Help us gather information about patients that may have experienced a negative outcome as a result of a plan forcing them to begin therapy with a baseline treatment.
Prevent Blindness is partnering with the American Academy of Ophthalmology (AAO) and American Society of Retina Specialists (ASRS) to gather information on patient and provider experiences with step therapy, also known as “fail first.” Fail-first policies are now permissible by Medicare Advantage plans, but private payers have used step therapy for years to help control costs. These policies often require patients and providers to receive prior authorization from plans to bypass drugs classified as a lower step treatment before receiving coverage for the treatment they are prescribed. We want to know if you or your patients have experienced negative outcomes as a result of a plan forcing patients to begin therapy with a baseline treatment.
Please the links below to share your story or encourage your patients to share their experiences. Stories from patients and providers will be used to educate policymakers on the negative implications of step therapy policies.
FOR HEALTHCARE PROVIDERS
Our coalition contends that CMS is failing to do enough to ensure that step therapy will not impede patients’ timely access to Part B drugs. It is our belief that CMS lacks the authority to permit its Medicare Advantage plans to impose such a coverage tool.
Medicare Advantage plans are now allowed to force step therapy for beneficiaries. CMS is permitting Medicare Advantage plans to require that patients’ treatment start with a drug chosen by the health plan — even an off-label option.
The agency says that step therapy allows Medicare Advantage plans the ability to negotiate drug prices, which could lower costs. However, Prevent Blindness and its partners believe that it inserts substantial obstacles between patients and their physicians’ recommended treatment options.