CSMS Joins AMA and Others in Calling for More Targeted PA Requirements

The Connecticut State Medical Society (CSMS) was one of nearly 100 state and national physicians’ advocacy organizations that signed a letter that the American Medical Association (AMA) sent to the Centers for Medicare & Medicaid Services (CMS) to urge it to “provide guidance to Medicare Advantage (MA) plans on prior authorization (PA) processes through its 2020 Call Letter.”

The letter states that, “CMS’ guidance should direct plans to target PA requirements where they are needed most. Specifically, CMS should require MA plans to selectively apply PA requirements and provide examples of criteria to be used for such programs, including, for example, ordering/prescribing patterns that align with evidence-based guidelines and historically high PA approval rates.”

It adds that, “PA programs can create significant treatment barriers by delaying the start or continuation of necessary treatment, which may in turn adversely affect patient health outcomes.”

The letter also emphasizes that physicians “have serious concerns about CMS’s recent notification to MA plans that they will no longer be prohibited from utilizing step therapy protocols for physician-administered drugs covered under Medicare Part B this year.”

Click here to read the letter sent to CMS on 2/28/19.