Humana Jumps In: Medicare Part B Step Therapy Program Includes Cancer Drugs
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.
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Fail first requirements for 2020 also target drugs for myelodysplastic syndrome and chronic obstructive pulmonary disease, building on the step therapy program launched by Humana in 2019.
Inclisiran's price relative to existing PCSK9 drugs will be key determinant in payer acceptance. Novartis says pricing will be within cost effectiveness range estimated by ICER.
Decision in final rule marks a setback in the Trump Administration’s game plan for lowering drug prices. But CMS proceeds with codifying previous guidance allowing step therapy for Part B drugs in Medicare Advantage.