Advocacy & Practice Updates — Clinical Updates
ASRS, AAO Meet With CMS to Seek Suspension of Avastin-First Step Therapy
ASRS and AAO met with CMS this week to update the agency on the ongoing difficulties retina patients and practices are experiencing following the decision by Pine Pharmaceuticals to discontinue repackaging Avastin. In the meeting, we noted that Pine was the largest supplier of repackaged Avastin and practices are encountering difficulty obtaining the drug in necessary quantities from other, smaller outsourcing facilities. At the same time, insurers have been unwilling to suspend or modify Avastin-first step therapy policies, putting patients at risk of not receiving treatment.
As in previous meetings with CMS, we reminded the agency that this market disruption is the latest in a long history of such disruptions and is unlikely to be resolved quickly. While we oppose step therapy in general, we contend that the Avastin-first step therapy policies are particularly egregious since they put patient safety at risk and hamper practices when these issues arise. We urged the agency to mandate insurers relax these policies during shortages. CMS was non-committal on potential action, but agreed to consider its options to address the situation.
You Can Help: CMS and payers need to hear from patients impacted by this shortage. Retina specialists and their practices can help patients get engaged by notifying them of difficulties obtaining Avastin and:
- Asking Medicare Advantage patients to call 1-800-MEDICARE or visit medicare.gov to complain when their plan has not granted a bypass to step therapy.
- Providing resources to patients now during Medicare Open Enrollment and educating them on their coverage options. Access ASRS resources here.
(Published 11.12.24)