Tag Archives: step therapy

Provider groups closely monitor Supreme Court case on pharmacy benefit managers

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

The U.S. Supreme Court this month heard oral arguments in the case of Rutledge v. Pharmaceutical Care Management Association. At issue is the right of states to regulate pharmacy benefit management (PBMs) companies, which employers and health plans hire as middlemen to manage their prescription benefit programs for workers and other plan members.

During oral arguments on Oct. 6, several justices asked about the burden that health plans encounter when PBM regulations differ from one state to another, as Rachel Cohrs reported for Modern Healthcare. Continue reading

Given that ‘step therapy’ is also called ‘fail first,’ there are many angles to pursue

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: ZaldyImg via Flickr

For journalists covering the Trump administration’s plan to expand step therapy to Medicare Advantage, there are important angles to cover now.

Under the rule issued by the federal Centers for Medicare and Medicaid Service, Medicare Advantage plans will now be able to use so-called step therapy when physicians prescribe drugs under Medicare Part B. Continue reading