Complete Story
02/14/2024
Humana
Aetna Managed Care Committee Member
Mary Stubitsch - Newland Medical Associates
Summary of Medicare Preauthorization and Notification List Changes
Last updated: Feb. 7, 2024
This list contains a summary of changes made to the current copy of the Medicare Preauthorization and Notification List. At Humana, we are dedicated to ensuring that every business decision we make reflects our commitment to improving the health and well-being of our members. To that end, we continuously evaluate our clinical programs, current medical literature, legislation and coding practices to help our members achieve their best health.
Summary of Commercial Preauthorization and Notification List Changes
Last updated: Feb. 7, 2024
This list contains a summary of changes made to the current copy of the Commercial Preauthorization and Notification List. At Humana, we are dedicated to ensuring that every business decision we make reflects our commitment to improving the health and well-being of our members. To that end, we continuously evaluate our clinical programs, current medical literature, legislation and coding practices to help our members achieve their best health.
Injectable Drugs and Biologics Step Therapy Requirement for Medicare Advantage Plans
Effective date: Jan. 1. 2024
Revision date: Feb. 7, 2024
In August 2018, the Centers for Medicare & Medicaid Services (CMS) rescinded its September 2012 memo “Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services,” which provided Medicare Advantage (MA) plans the option of applying step therapy for physician-administered and other Medicare Part B drugs.1 Because of this change, Humana added step therapy requirements for some drugs on our preauthorization list in 2019.
CMS issued a final ruling on May 16, 2019, that modernizes and improves the MA program.2 These changes updated CMS requirements for the Part B Step Therapy Program, enabling MA plans to negotiate better prices for physician-administered drugs under Medicare Part C. The changes that resulted from this final ruling were implemented on Jan. 1, 2020.
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