Inside Health Policy: HHS May Stop Step Therapy In One Instance, While Pushing It In Another

This post originally appeared in Inside Health Policy on February 12, 2019. 
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HHS may stop the insurance industry practice of making seniors fail on drugs that have already failed for them when switching to a new Medicare drug plan, HHS Secretary Alex Azar told the American Medical Association Tuesday (Feb. 12).The practice is known as step therapy, though patient advocates often call it fail first. Azar learned of that application of the practice in meetings with patients and doctors who are urging against a separate HHS proposal to use step therapy more broadly in six protected drug classes.

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 “I was very disturbed in this process to hear that stable patients switching among insurance plans, like switching among Medicare Advantage plans or Part D plans each year, can often be required to start over again on a fail-first or step therapy regimen.”

Azar said making patients retry drugs they’ve already failed on is bad for patients and ends up costing the health care system more in the long run. Getting patients on drugs that work for them is one of the best investments that can be made in the health care system, he said.

“So, we’re looking at how we can address that issue."

However, he defended his proposal to let Medicare plans use step therapy and prior authorization for drugs in protected classes. He said plans already use those tactics in the commercial market, and while he acknowledged that patients and doctors worry that step therapy and prior authorization will impede access, he said high prices also impede access.
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“Bringing down these costs without blunt restrictions on patient access has got to involve pitting drug companies against each other,” he said. “And that means giving drug plans some power to steer patients toward one product before another.”