On Aug. 7, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced that the agency would rescind previous CMS policy prohibiting the use of step-therapy protocols by Medicare Advantage plans. Starting in January 2019, Medicare Advantage plans will be allowed to use step therapy for all physician-administered drugs covered under Medicare Part B. The administration's new policy would also allow step-therapy protocols that span both Parts B and D, meaning a Medicare Advantage plan could require a patient to first try a drug covered under Part D before providing coverage for a Part B drug. According to the agency's announcement, this change in policy was made as part of the administration's plans to lower drug prices. 

The AMA has serious concerns about the agency's change of policy given its potential for significant impact on patient access to critical therapeutics and increased administrative burdens on physician practices. The AMA is working closely with physician specialty organizations and state medical societies to limit the potential negative impacts of this policy shift.