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 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.

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 ...

ASTP/ONC issued three health IT certification criteria related to drug cost transparency and prior authorizations initially ...

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 ...

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).

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 ...

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.

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.