The medical oncology community is opposing the Trump administration’s plan to allow Medicare Advantage plans to use “step therapy” for Part B drugs. More than 90 organizations, including the American Society of Hematology, have written a letter to the Centers for Medicare & Medicaid Services (CMS) calling on the agency to retain a 2012 policy that prohibits these plans from using step therapy.
Under the new step-therapy policy, Medicare Advantage plans, administered by private health insurers, could require patients to try a cheaper therapy before attempting a more expensive one. According to CMS Administrator Seema Verma, MPH, step therapy will “encourage patients to choose high-value medications,” leading to increased competition and lower drug prices. The new policy would take effect in January 2019, though details are still scarce.
Patient groups, drug manufacturers, and others have expressed skepticism that step therapy would lower drug prices or protect patients’ interests. The medical community’s letter, also signed by the American Medical Association, the American Society of Clinical Oncology, and the American Society for Radiation Oncology, voiced their concerns that the new policy would be particularly harmful for patients receiving treatment for cancer and other life-threatening conditions. For patients with cancer, the letter states, “selecting the proper personalized treatment as quickly as possible can be critical to survival.”
Community Oncology Alliance Medical Director Fred Schnell, MD, put the policy in starker terms. “The choices really can be life-or-death choices. A bad choice can lead to bad outcomes that are not reversible,” Dr. Schnell argued. “Patients may never recover from a bad choice.”