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Medicare Advantage change may lower Part B drug prices
Modern Healthcare

The CMS will allow Medicare Advantage plans to require that patients try low-cost generics before stepping up to more expensive therapies.

Late Tuesday, the CMS announced that MA plans can now impose step therapy on Part B drugs. Step therapy allows a plan to determine whether patients should first get a low-cost generic and then work their way up to a more costly product if the initial treatment is ineffective.

MA plans already have this authority for Part D drugs, which are drugs provided at pharmacies.  This latest move allows prior authorization for drugs administered in doctors’ offices.

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