Medicare Advantage Prescription Drug Policy Change Causes Concern

Consumer advocate groups claim that enrollees with chronic conditions will be adversely affected.

Consumer groups were quick to voice concern about a plan unveiled yesterday by CMS that will allow Medicare Advantage plans next year to negotiate lower prices for Part B drugs that are administered by a doctor. Beginning next year, MA plans will be able to use step therapy (a tool often used by private insurers), giving them the option of offering patients the least expensive therapy first. Step therapy allows private insurers to negotiate discounts of 15 to 20% or more, while Medicare essentially pays the full price. 

But as theHill reports, the plan could have a negative impact on patients with chronic conditions, patient advocate groups claim. Ellen Albritton, a senior policy analyst at Families USA, a left-leaning health care advocacy organization based in Washington, tells the Hill: “This policy, instead of really getting at the heart of the matter of lowering high drug prices, is putting up more barriers between patients and the drugs they need to stay healthy and live.”

The policy takes effect January 1. Patients already receiving drugs through Part B will see no change; only new prescriptions will be affected. MA plans that participate in the step therapy program will have to disclose to enrollees that their covered drugs might be subject to new rules. “Patients will be allowed to switch to a different plan through March 31 if they’re unhappy with the changes,” the Hill reports.