Posted on December 4th, 2018
Vanessa Sink
Public Affairs Manager
The following is a statement by Leslie Fried, Senior Director of the National
Council on Aging (NCOA) Center for Benefits Access on the publication of
proposed regulations, Modernizing Part D and Medicare
Advantage to Lower Drug Prices and Reduce Out of Pocket Costs:
“The National Council on Aging (NCOA) is critically concerned
about the Centers for Medicare and Medicaid Services (CMS) proposal to allow
Medicare Advantage and Medicare Part D prescription drug plans to utilize step
therapy.
“Since the beginning of the Medicare drug benefit, Congress and
CMS have accepted that certain seriously ill and medically compromised Medicare
beneficiaries must have access to the drugs prescribed to them in order to
adequately manage their condition. That’s one of the reasons why there are six
protected classes in Part D. Requiring chronically ill and frail individuals to
‘fail first’ before allowing them to ‘step up’ to a prescribed medication could
have major and life-threatening consequences for these individuals. Restricting
treatment options places an emphasis on initial cost over efficacy, which
undermines the basic principal of health care providers to ‘do no harm.’
“We have similar concerns about the proposal to allow Medicare
Advantage plans to use step therapy for Part B drugs, including in the
treatment of life-threatening conditions like cancer. CMS even acknowledges
that it expects this change to lead to consumer pushback by including changes
to the adjudication time periods for Medicare Advantage appeals for Part B
treatments. This reliance on the appeals process is insupportable. The Medicare
appeals process does not provide adequate safeguards to protect beneficiaries
from these harmful and detrimental proposals. As a matter of fact, flaws in the
Medicare Advantage appeals process were highlighted in a report by the HHS Office of Inspector General in
September 2018.
“These two proposals will affect our frailest citizens who may
not have the wherewithal to engage with a difficult appeals process – even if
they know it’s an option. We urge CMS to reconsider and withdraw any proposals
that will cause harm to the health and well-being of Medicare beneficiaries.”
About NCOA
The National Council on Aging (NCOA) is the national voice for
every person’s right to age well. NCOA empowers individuals with trusted
solutions to improve their own health and economic security—and protects and
strengthens federal programs that people depend on as they age. Working with a
nationwide network of partners and directly with individuals, NCOA’s goal is to
improve the lives of 10 million older adults by 2020. Learn more at ncoa.org and @NCOAging.
https://www.ncoa.org/news/press-releases/ncoa-statement-proposed-regs-cms-step-therapy/?utm_source=newsletter&utm_medium=email&utm_campaign=12042018_NCOAWeek
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