The Centers for Medicare and Medicaid Services (CMS) issued a final rule that makes no changes to the current six protected classes policy — completely eliminating the potentially damaging changes included in a proposed rule released several months earlier. Instead, the agency finalized current practices that allow for prior authorization (PA) and step therapy (ST) to only be used within the protected classes for new starts. Also consistent with current practice, antiretrovirals remain excluded from utilization management altogether. Importantly, CMS did not finalize exceptions for new formulations of existing drugs or drugs whose prices increase above the urban consumer price index (CPI-U).
A new Medicare regulation could force hundreds-of-thousands of seniors and people with disabilities to lose access to the medications they use to treat conditions including cancer, HIV, mental health conditions, epilepsy, organ transplants, and others. Join this webinar to learn how you can make a difference.
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