Protecting Patient Access: Advocating Against Barriers in Medicare Part D
Published December 12, 2024
Today, the Alliance for Aging Research, alongside 36 partner organizations, sent a letter to the Centers for Medicare & Medicaid Services (CMS) urging the Agency to take action to safeguard Medicare beneficiaries’ access to necessary therapies amid upcoming changes to the Medicare Part D program in 2025. The letter highlights our growing concerns that without additional safeguards, new cost-sharing responsibilities for plans could result in an overreliance on utilization management (UM) tools like step therapy, prior authorizations, and drug quantity limits—tools that will restrict access to appropriate care and delay treatments.
As plans’ financial liability increases significantly in the catastrophic phase of coverage under the redesigned Part D benefit, the likelihood that plans will begin to use aggressive UM measures also grows. These tools often place significant burdens on patients and providers, both financially and logistically. For example, step therapy forces patients to “fail first” on less expensive treatments before accessing their prescribed therapies, potentially leading to delays in care, disease progression, and worse health outcomes.
The Alliance and its partners are calling on CMS to go further in protecting beneficiaries by increasing transparency around UM practices, enhancing beneficiary education about potential plan changes, and detailing CMS’s plans to monitor and prevent inappropriate UM activities. These steps are essential to ensuring that Medicare beneficiaries retain access to medically necessary treatments without unnecessary hurdles.