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House Appropriations Committee Includes Report Language Expressing Concerns about Prior Authorization and Step Therapy Policies on Medicare Beneficiaries

On Wednesday, the House Appropriations Committee released its report on the FY 2020 Health and Human Services (HHS) appropriations bill, which includes language raising concerns regarding the impact of prior authorization (PA) and step therapy policies on Medicare beneficiaries. The Committee directs CMS to improve Medicare beneficiaries’ timely access to care, increase transparency, and reduce the burdens on patients and physicians by providing guidance to Medicare Advantage (MA) plans on their use of PA. Specifically, CMS should require MA plans to selectively apply PA requirements, and exclude services that align with evidence-based guidelines and, when subjected to PA, have high approval rates.

Additionally, the Committee expressed concern for the proposed rule, ‘‘Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses,” as it would increase use of PA and potentially delay access to important treatments for serious illnesses. While this language is not legally binding, its inclusion is positive. In the meantime, ASCRS ASOA and others in the medical community continue to advocate to reduce burdens associated with prior authorization and oppose expanding the use of step therapy in MA Part D.

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