Are Medicare Advantage (MA) plans allowed to require patients to go through “step therapy” to get a medication or treatment they need? Yes — for now — but physician groups are trying to change that.
The use of step therapy also poses problems for gastroenterology patients, according to James Weber, MD, president of the Digestive Health Physicians Association, another signatory to the letter. “For my patients with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, step therapy can lead to serious complications while waiting for the right medication, such as emergency department visits, hospitalization, and even surgery,” Weber wrote in an email. “Patients rightly expect me to use my best judgment when deciding what medications to prescribe. We should end the practice of allowing insurers to mandate that my patients try medications I know will not work before allowing them to take the drug I judge to be most effective.” Read More at MedPage Today >>