Calls for Step Therapy Prohibition Continue

Earlier this month, nearly 80 organizations, spanning medical specialty societies, patient advocates and caregiver support groups, joined voices AGAIN to tell leaders at the Centers for Medicare and Medicaid Services (CMS) that step therapy policies are harming Medicare’s most vulnerable patients and these practices must be prohibited. Patients and Providers United stands with physicians, patients and caregivers in its commitment that every patient receives the right treatment in the right setting at the right time.

The June 2022 letter to CMS echoes the sentiment expressed by many of these same organizations in an April 2021 letter to HHS Secretary Xavier Becerra. Why send the same letter over and over again? Because it is that important. Because timely access to therapies that patients need to properly manage complex medical conditions is still impeded. Because delays in obtaining the medicines that doctors know will yield a patient the best outcomes continue to result in increased costs for the Medicare program and patients.

Step therapy or “fail first” policies force patients to go through months of ineffective treatment with second or third choice medications before the drug therapy originally prescribed by their doctor is finally covered. Along with health setbacks and disease progression, patient copayments/cost sharing accompany these many rounds of ineffective prescriptions and subsequent follow-up treatment visits. Patients lose when that medical expertise encounters rigid, unworkable, cost-containment benchmarks of an insurance plan. It is more important than ever that the personalized treatment plans physicians craft to meet the unique needs of each patient are not obstructed due to bureaucratic utilization management policies like step therapy.ts, priorities are dangerously off-track.