This Week – August 18, 2018

This Week in Washington, D.C.

  • Call to Action: Urge your representatives to sign onto the congressional letter opposing “step therapy” prior authorizations!

Call to Action:
Urge your representatives to sign onto the congressional letter opposing “step therapy” prior authorizations!

On Tuesday, August 7th, several important updates to the Medicare Advantage (MA) program were announced by CMS which could affect your patients and practice. Beginning January 1st, 2019, MA plans will have the opportunity to impose step therapy rules for Part B drugs for new prescriptions.  Step Therapy, a type of prior authorization, entails the “fail first” drug therapy requirements, in which patients are forced by insurers to try and fail with one or more medications before the insurer approves the cost of the medication which ACG members originally prescribed.

Though CMS claims that the imposition of this rule will help save money for Medicare beneficiaries and the program as a whole, ACG Governors and members continue to express their frustration over the amount of time and resources that GI practices are forced to spend dealing with insurers and prior authorizations, at the detriment to patient care. These policies are not rooted in clinical evidence, and ultimately take valuable time away from treating patients.

We need your help in voicing these concerns to CMS!  Representatives Phil Roe (R-TN) and Ami Bera (D-CA) have drafted a letter to CMS Administrator Seema Verma, requesting that CMS review these proposed changes to the Medicare Advantage plan, in order to “help increase transparency, streamline prior authorizations, and minimize impact on patients.”  Click the link below to reach out to your representatives, and ask them to sign onto this bipartisan letter!

Click here to take action now!

Click here to take action on the federal step therapy bill, “Restoring the Patient’s Voice Act of 2017” (HR 2077)!