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Payers, providers clash on CMS' plans for step therapy in Medicare Part B

January 29, 2019 / Paige Minemyer

Payers and providers are decidedly split when it comes to CMS’ proposals to allow step therapy for Part B drugs, while insurers want to the agency to take its plans for negotiation in Part D's protected classes further. The comment period on the Centers for Medicare & Medicaid Services' November proposed rule establishing both policies ended Jan. 25, and the submitted responses continue a debate that has raged in the industry since CMS announced last summer its plans to allow Medicare Advantage (MA) plans to implement step therapy in Part B. Humana, one of the country’s largest MA insurers, wrote in a comment letter (PDF) that it has long backed such policies to stimulate competition in the Part B market and lower prices for beneficiaries.