New Medicare Advantage Tool to Lower Drug Prices Puts Crimp in Choices

New rules taking effect in 2019 will allow Medicare Advantage plans to require patients to try less expensive drugs before covering costly, physician-injected treatments for serious conditions including cancer and rheumatoid arthritis, reports Kaiser Health News . While the transition to "step therapy" is part of the Trump administration's campaign to check runaway pharmaceutical pricing, some warn that critically ill Medicare Advantage patients could suffer if they do not receive the first line of treatment recommended by their doctor. A patient with macular degeneration, for example, might go blind before receiving approval for vision-saving eye injections. Step therapy is not even permitted under traditional Medicare, and insurers that take advantage of the change in Medicare Advantage will only do so as it applies to new prescriptions. However, the shift will also give them some negotiating leverage with pharmaceutical companies, according to Seema Verma, the head of the Centers for Medicare and Medicaid Services. Drugmakers looking to remain competitive might lower their prices in order to secure their product a slot of plans' formularies, which would then allow patients to get the medication without satisfying step therapy prerequisites. Medicare also is demanding that plans share any savings with subscribers.