In Part D, prior authorization is a coverage determination and can include step therapy. This is when the plan requires a person to try a cheaper drug before approving a costlier one.

In Medicare Part D, prior authorization is called a coverage determination. Specifically, in the case of Part D, prior authorization may also involve a process known as step therapy.

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

The Centers for Medicare and Medicaid Services (CMS) will implement prior authorization requirements for certain traditional fee-for-service Medicare services in six states starting next year.

“Combining the speed of technology and the experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while ...

The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model late last week to streamline some prior authorizations under the traditional Medicare program, but some ...

Prior authorization reforms, increased biosimilar access and the future of the Medicare drug price negotiation program are among the American College of Rheumatology’s top concerns in a letter ...

Medicare Advantage prescription drug plans used prior authorization (90.3% vs 71.9%) and quantity limits (22.5% vs 16.5%) significantly more often than Part D prescription drug plans (both P < .001).

Step therapy is when Medicare Part D plans ask beneficiaries to try a more affordable drug before approving higher-cost prescriptions. In Medicare, Part D covers general prescription drugs ...