CMS Final Rule Codifies Existing Policy On Step Therapy For Part D Protected Drug Classes
The Centers for Medicare & Medicaid Services (CMS) has finalized a rule to maintain its existing 2006 policies on prior authorization and step therapy for Part D protected medication classes. The Part D protected classes include antidepressants, antipsychotics, anticonvulsants, immunosuppressants for treatment of transplant rejection, antiretrovirals, and antineoplastics. Effective January 1, 2020, Medicare Part D plans can establish prior authorization and step therapy for only members initiating treatment with five of the six protected classes: antidepressants, antipsychotics, anticonvulsants, immunosuppressants, and antineoplastics. Prior authorization and step-therapy will not be permitted for Part D members initiating treatment with antiretrovirals.
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