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.

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.

Check your plan’s formulary (for Part D) and Part B coverage rules. Consider working with a Medicare-savvy pharmacist or agent if you take specialty drugs.

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.

Getting coverage authorization for certain medications from Medicare may require you to try a cheaper drug first. This is called “step therapy.” Medicare Part D offers general prescription ...

Part D plans organize medications into cost-based tiers and may require steps like prior authorization, quantity limits or step therapy. Costs may include premiums, deductibles, co-pays or ...

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 ...

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 ...

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.