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What You Need To Know About Medicare Part B Step Therapy: AMCP Nexus 2022


Yuqian Liu, Pharm.D., and Michelle Booth, Pharm.D., of Magellan Rx Management, discuss the background and consequences of step therapy in Medicare Part B in an interview prior to their session at the AMCP Nexus 2022 meeting in National Harbor, Maryland.

This interview was recorded prior to the meeting.

CMS has estimated that step therapy for Part B drugs in Medicare Advantage plans could save the Medicare program over $1.9 billion from 2020 to 2029 years, according to Yuqian Liu, Pharm.D., senior director of specialty clinical solutions at Magellan Rx Management.

Liu said CMS has estimated that step therapy will save beneficiaries about $62 million in out-of-pocket costs during the same period.

Liu and her colleague, Michelle Booth, spoke to Managed Healthcare Executive® prior to their presentation about Part B step therapy in Medicare Advantages scheduled for today at AMCP Nexus 2022 meeting in National Harbor, Maryland.

Michelle Booth, Pharm.D., also a senior director of specialty clinical solutions at Magellan, said most plans were cautious about jumping into step therapy.

"A lot of folks started small (with step therapy) and then expanded based on where their utilization was and where they kind of felt like the biggest bang for their buck was," Booth told Managed Healthcare Executive®.

Cost savings for the plans were quite high from the program at first , then decreased after the first year. However, Booth feels savings have been "fairly stable."

Booth also noted that some time and effort went into developing care coordination programs that CMS had indicated would be required but then changed course and decided not to require them.

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