The Alliance of Specialty Medicine sent formal comments to the Centers for Medicare and Medicaid Services (CMS) urging the agency to finalize proposed policies that would meaningfully improve utilization management (UM) and plan marketing in the Medicare Advantage (MA) program. Specific to utilization management, the specialists highlighted the importance of the reforms for specialty physicians and their patients, who are often subject to prior authorizations and other UM tactics, and asked the agency to expand its proposals to Part D. In addition, the Alliance urged CMS to rescind its step therapy policies in light of the proposed changes, and at a minimum, revise the guidance so it’s consistent with the continuity of care proposals.
The specialty group also urged CMS to finalize its MA and Part D marketing reforms, highlighting the challenges beneficiaries have faced when they enroll in MA and later discover their specialist is not in the network and their medication is off-formulary, not preferred, or cost prohibitive. Read the full letter to learn more about other issues facing specialty physicians and patients in Medicare Advantage.
