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CMS Allows Step Therapy Requirements for Medicare Part B Drugs

August 10, 2018


The Centers for Medicare & Medicaid Services (CMS) announced a new guidance Aug. 7 that recognizes Medicare Advantage plans may use step therapy for Medicare Part B drugs.

Replacing a 2012 guidance that prohibited imposing step therapy for access to Medicare Part B drugs, the new guidance would allow Medicare Advantage plans to require a Medicare Part D drug therapy prior to allowing a Medicare Part B drug therapy. The new guidance takes effect Jan. 1, 2019.

CMS said it hopes the new guidance will give Medicare Advantage plans the ability to negotiate Medicare Part B drug prices with manufacturers. It also requires that the plans pass half the savings from the negotiations on to the patient.

“In this guidance, CMS is acknowledging that the use of step therapy is a recognized utilization management tool,” CMS said in the announcement. “The allowance of step therapy practices for Part B drugs will help achieve the goal of lower drug prices while maintaining access to covered services and drugs for beneficiaries.”

View the announcement.

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