March Advocacy Updates
March 28, 2023
Needed MVP Improvements Outlined in Letter to CMS
Some specialties have a new voluntary way to meet Merit-based Incentive Payment System (MIPS) reporting requirements—MIPS Value Pathways (MVPs). Each MVP includes a subset of measures and activities that are related to a specialty or medical condition and is intended to offer more meaningful and less burdensome participation in MIPS. For 2023, there are 12 MVPs. The physician community is concerned MVPs are repeating many of the problems with traditional MIPS—notably a lack of clinical relevance to physicians and administrative burden. In a letter to CMS, ACOI and other societies have made recommendations on the transition to MVPs and are encouraging they remain a voluntary reporting option.
ACOI Endorses Step Therapy Legislation
ACOI has endorsed legislation that would require group health plans governed by ERISA to provide an exception process for any medication step therapy protocol, including when a patient is stable on his/her current medication. The Safe Step Act (S. 652) has been reintroduced in the Senate by a bipartisan group of lawmakers led by Sens. Lisa Murkowski (R-AK) and Margaret Hassan (D-NH). Introduction of companion legislation in the House is expected.
In a press release issued by Sen. Murkowski, ACOI President Dr. Joanne Kaiser-Smith was quoted as saying, "Patients are caught between the high cost of prescription drugs and the use of step therapy protocols by insurance companies. The Safe Step Act creates clear exceptions to step therapy protocols to ensure that medical decisions made by physicians in consultation with their patients are respected, and the health and safety of patients are a priority. ACOI is pleased to offer its strong endorsement of the legislation and calls for its passage by Congress.”
In the previous Congress, the legislation had the cosponsorship support of 197 House members and 36 senators but failed to receive formal consideration.
In related news, in February ACOI joined a letter led by the American Academy of Ophthalmology that asked CMS to reinstate the step therapy prohibition in Medicare Advantage plans for Part B drugs.
Osteopathic Community Supports Proposed Electronic Prior Auth Requirements
ACOI recently joined the osteopathic community in a letter to the Centers for Medicare and Medicaid Services (CMS) in support of proposed policy changes that would streamline and improve transparency of prior authorization (PA) processes across health plans, including Medicare Advantage, Medicaid, CHIP and Qualified Health Plans on the Federally-Facilitated Exchanges. The groups expressed support for CMS’ proposal to require plans to support electronic PA via a standards-based application programming interface (API), although the requirement would exclude drugs from the electronic PA requirements.
The groups supported CMS’ proposal to shorten the timeline for PA decisions, although requested that CMS finalize a timeline of 72 hours for standard requests and 24 hours for urgent requests, rather than one week for standard requests and 72 hours for urgent requests as proposed.
The groups also asked CMS to finalize rules for transparency that would require the reporting of more granular information about plan approvals and denials based on specialty or service rather than just in aggregate and gave support to a proposed requirement for health plans to provide a specific reason for a PA denial.