Potential CMS changes to Medicare formulary design

Today at the Academy of Managed Care Pharmacy (AMCP) 2019 Annual Conference, I attended a session titled “Medicare Formulary Updates Impact. How will proposed recent rulemaking affect formulary design? Some answers are below. CMS 2020 draft call letter Improved access to opioid reversal agents. The CMS 2020 draft call letter would place opioid reversal agents…

The problem with step therapy

Step therapy is good in theory, but often not in practice.  In step therapy, patients are required to try one drug first–typically a low cost and/or high-value treatment–before moving on to more expensive alternatives.  In theory, this is a great idea.  The first drug patients should try should be the highest value one. In practice, however,…