Late last year, Health and Human Services (HHS) and The Center for Medicare and Medicaid Services (CMS) announced several major initiatives focused on lowering drug prices for Medicare and its beneficiaries. CMS’s plan to modernize the Part D program and Medicare Advantage plans would enable changes to six protected classes in Medicare, allowing fail-first step therapy in MA Plans, and make changes to the definition of “negotiated prices” to increase transparency.
While USR supports the goal of lowering healthcare costs, we believe that one of the proposed rules, if implemented, would harm patients, damage the patient-physician relationships, risk increasing costs, and increase the administrative burden on providers. In late January, USRetina submitted a formal comment letter to the Center of Medicare and Medicaid Services (CMS) regarding CMS-4180-P: Proposed Rule Allowing Medicare Advantage Plans To Implement Step Therapy.
While several Ophthalmology Organizations (American Association of Ophthalmology and American Society of Retinal Surgeons) submitted comments opposing the proposed rule, USRetina felt that these responses did not specifically address the clinical implications to our patients.
Our discussions with senior CMS leaders highlighted the importance of proposing solutions in addition to highlighting the problems. While our response opposed the proposed rule, we also proposed alternatives that will enable policy makers and political leadership to develop solutions that address the public’s warranted concern over high drug cost while preserving patient safety and enabling retina physicians to provide the most efficacious care. Most importantly, care which is based on the consent between the physician and the patient that maximize their outcome.