New Findings on Insurance from Tufts Medical Center Summarized (Varied Use of Step Therapy Among Medicare Advantage Plans): Insurance

2024 MAR 14 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Current study results on Insurance have been published. According to news originating from Boston, Massachusetts, by NewsRx correspondents, research stated, “First, to examine 7 large Medicare Advantage (MA) plans’ use of step therapy. Second, to compare step therapy that health plans imposed in their MA and commercial (employer) drug coverage policies. Database analysis.”

Financial support for this research came from Genentech.

Our news journalists obtained a quote from the research from Tufts Medical Center, “Using data from the Tufts Medical Center Specialty Drug Evidence and Coverage Database, we evaluated 7 large MA plans’ use of step therapy in their Part B drug coverage policies. First, we determined the frequency with which different MA plans applied step therapy. Second, we determined the frequency with which plans imposed step therapy protocols across International Classification of Diseases, Tenth Revision, Clinical Modification categories. Third, we compared each step therapy protocol against each drug’s corresponding FDA label indication. Fourth, we examined the consistency of step therapy protocols between the same insurer’s MA and commercial lines of business. The frequency with which the included MA plans imposed step therapy ranged from 26.1% to 63.7%. Step therapy was most common for dermatology conditions (90.2%) and least common for oncology conditions (28.6%). On average, MA plans’ step therapy requirements were consistent with the drug’s FDA label indication 29.0% of the time. MA plans’ and commercial plans’ use of step therapy differed for the same drug-indication pairs 46.1% of the time. MA plans vary in the frequency with which they impose step therapy protocols in their Part B drug coverage policies. Moreover, insurers often impose different step therapy protocols in their MA plan and commercial plan offerings.”

According to the news editors, the research concluded: “Differences in plans’ step therapy requirements may result in variability in patients’ access to care within MA.”

This research has been peer-reviewed.

For more information on this research see: Varied Use of Step Therapy Among Medicare Advantage Plans. The American Journal of Managed Care, 2023;29(9). The American Journal of Managed Care can be contacted at: Managed Care & Healthcare Communications Llc, 666 Plainsboro Rd, Ste 300, Plainsboro, NJ 08536, USA.

The news correspondents report that additional information may be obtained from James D. Chambers, Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Center for the Evaluation of Value and Risk in Health, 800 Washington St, Boston, MA 02111, United States. Additional authors for this research include Nola B. Jenkins, Daniel E. Enright and Donald E. Nichols.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.37765/ajmc.2023.89426. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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