USRetina’s Response to CMS Regarding Step Therapy

USRetina is advocating for best course of eye care treatment for our practices and our patients. Recently, our Chief Medical Officer Dr. Sunil Gupta, corresponded with CMS on “Step Therapy.” USRetina has been busy advocating with insurance companies as well.

Step Therapy is a “fail first” policy that insurance companies use which require the least expensive drug/treatment to be tried first – regardless of its effectiveness in treating a condition instead of the drug originally prescribed by the physician. Additionally, patients are usually required to seek authorization from their insurance provider before they can begin treatment. Patient may even learn after their doctor has prescribed the treatment that they need to try a cheaper, potentially less effective drug than was prescribed first and must show that the drug isn’t working before insurance will cover a more expensive and possibly more effective treatment.

The impact to eyesight can be significant given that this process often results in treatment delays, additional doctor visits, and insurance pre-approval. Delaying patient’s access to the treatment of his or her choice that has been prescribed by a provider of his or her choosing means time lost in stemming progressive loss of sight.

Controlling health care costs is important and necessary; however, USRetina is concerned that relying on a Step Therapy policy places an undue hardship on patients who are facing advancing loss of vision – patients who may not have the luxury of time to try multiple treatments before losing their sight.

USRetina and our practices passionately support the patient/doctor relationship and the patient’s choice in making their own treatment decisions. These decisions are a collaboration between physician and patient and are grounded in the best interest of patient health, in our case your eyesight.  Please add your voice to ours as we advocate with CMS and the insurance companies for physician/patient rights to determine the best course of care and least risk of progressive loss of sight.

Drug and treatment choice should be between the patient and the doctor and not the insurance company.


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