Industry Voices—How the Trump administration’s step therapy policy changes will affect Medicare Advantage plans

Last year, the Trump administration, Health and Human Services (HHS), and the Center for Medicare & Medicaid Services (CMS) announced proposed changes to Medicare. One specific change that went into effect at the beginning of 2019 is allowing Medicare Advantage (MA) plans to apply step therapy practices for medications that are covered under Medicare Part B. Though this change is highly debated, I’m going to break down the details related to step therapy for MA plans and Part B medications. On Aug. 7, 2018, CMS released a memo (PDF) announcing that beginning Jan. 1, 2019, Medicare Part C (Medicare Advantage) plans, which are run by private insurers, can choose to use step therapy for Part B drugs, as a part of patient-centered care coordination. Step therapy means patients are required to try preferred drug or treatment options before "stepping up" to medications that cost more.