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UnitedHealthcare and AMA clash over Medicare's step therapy changes

September 05, 2018 / Evan Sweeney

A recent policy change that would allow Medicare Advantage plans to use step therapy for Medicare Part B drugs is creating yet another dividing line between insurers and providers. UnitedHealthcare—the nation’s largest Medicare Advantage carrier, with a prominent voice in the ears of federal officials—says new regulations around step therapy will give payers the flexibility to bring down drug costs for Medicare Part B beneficiaries by nurturing a burgeoning biosimilars market. Meanwhile, the American Medical Association (AMA) is worried about the new policy—which serves as a type of prior authorization requiring patients to try a less-expensive option before graduating to a higher cost brand name drug—will lead to “unnecessary red tape” and that patients will see more denials as a result of the new policy.