Source:

Press Release

November 02, 2021
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AAO, ASCRS warn of prior authorization, step therapy restrictions in open enrollment

Source:

Press Release

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Consumers should be aware of Medicare Advantage plans limiting therapy through prior authorization and step therapy requirements during open enrollment, according to a press release from AAO and ASCRS.

Prior authorization, the practice of requiring providers to gain approval from insurance agencies before the therapy will be covered, was recently instituted by Aetna for cataract surgery.

“Aetna’s new prior authorization policy for cataract surgery is a troubling example of a health plan restriction that has made it more difficult for Medicare Advantage enrollees to access sight-saving care,” David Glasser, MD, secretary for federal affairs for the AAO, said in the release, which was issued by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery. “As the nation’s ophthalmologists continue to fight these care delays and denials on behalf of our patients, we also want consumers to be aware of the restrictions some insurers are imposing so they can choose Medicare Advantage plans accordingly.”

In addition to prior authorization restrictions, consumers should be aware of step therapy restrictions in Part B plans, according to the release. Step therapy requires patients to fail on an insurer-prescribed therapy before the provider-determined therapy will be covered.

“Requiring these beneficiaries to step through a plan-selected drug regimen before accessing treatment recommended by their trusted health care provider can have devastating consequences for patients with vision disorders, including the risk of irreversible blindness,” George Williams, MD, a retina specialist and spokesperson for the AAO, said in the release.

Open enrollment ends on Dec. 7, 2021.