Step Therapy Creates Barriers to Care for Medicare Advantage Beneficiaries with Cancer

Statement by Monica M. Bertagnolli, MD, FACS, FASCO, President of the American Society of Clinical Oncology (ASCO)
August 8, 2018

"ASCO strongly opposes the Centers for Medicare & Medicaid Services (CMS) decision to allow Medicare Advantage plans to employ step therapy across physician-administered and self-administered drugs under Medicare Part B and Part D.

"In modern cancer care there is frequently a lack of interchangeable treatment options, and optimal care requires patient access to the most medically appropriate drug at the most opportune time based on the highest quality evidence. Step therapy requires patients to try and fail to have a desired clinical outcome on a lower cost medication before they can access the medication prescribed by their health care provider. This not only delays patient access to proper treatments, it potentially leads to irreversible disease progression and other significant patient health risks.

"We strongly urge CMS to reverse this decision. ASCO will continue to oppose any utilization management policy by payers that restricts patient access to high-quality cancer care, and we are ready to work with the agency toward policies that reflect the current realities of treating patients with cancer."