Step Therapy For Medicare Part B Drugs Will Lower Costs By 20%, HHS Projects
Beginning in 2019, Medicare Advantage plans may use step therapy in Part B, potentially including “cross management” with Part D drugs, under new guidance from the Centers for Medicare and Medicaid Services.
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US insurer’s commercial plans will favor the originator drug over biosimilars in return for a price concession from Amgen, while UnitedHealthcare’s Medicare Advantage plans will prefer biosimilars in several categories.
Biopharma manufacturers view implementation of management tool in Medicare Advantage plans with concern, urge US Centers for Medicare and Medicaid Services to withdraw permission for use of step therapy for Part B drugs.
CMS proposed rule would not eliminate any protected classes but would allow plans to impose additional restrictions on drugs in those classes. Proposal also codifies step therapy for Part B drugs.