Ben Jones Discusses the Impact of Step Therapy in Medicare Advantage

June 7, 2019

This is probably the biggest concern that every community and cancer practice should be looking at, explained Ben Jones, vice president, Government Relations & Public Policy, McKesson Specialty Health.

This is probably the biggest concern that every community and cancer practice should be looking at, explained Ben Jones, vice president, Government Relations & Public Policy, McKesson Specialty Health.

Transcript

CMS has proposed allowing step therapy in Medicare Advantage plans for Part B drugs. How do you think this will impact cancer patients?

This is probably the biggest concern that every community and cancer practice should be looking at. The president has come out with a number of proposals included in the drug pricing blueprint that have a specific impact on Part B drugs. The secretary made it clear when the drug pricing proposal was released that his desire was to, as much as his ability allows, move Part B drugs into Part D. In absent the ability to kind of make an easy shift into Part D, what he wants to do is mimic some of the characteristics that Part D has in the Part B space. That’s why you’re seeing such quick action on step therapy, on a relaxing of the protected classes, and on a number of utilization management tools that are likely to come down the pipe.

I do think that this is something that has the biggest potential to threaten access to care for cancer patients across the country. These are just 2 examples. Step therapy and protected classes have already been finalized. The changes to both of those proposals have been finalized in Medicare Advantage, but we’ve also got another proposal with the International Pricing Index that again has the potential to insert a new third-party vendor into the drug supply chain, impacting access to patient timely care and potentially a new round of utilization management tools.