MAOs’ Use of Prior Authorization for Part B Drugs

OBJECTIVE

Medicare Advantage Organizations (MAOs) are generally allowed to require prior authorization for certain services.  Since 2019, Federal regulation has allowed MAOs to use step therapy—a type of prior authorization that requires patients to start treatment with the plan’s preferred drug(s) and progress to the plan’s nonpreferred drug(s) only if necessary—for Part B drugs.  However, provider and patient advocacy groups have raised concerns that MAOs may be using prior authorization and step therapy for Part B drugs in ways that do not adhere to program requirements, do not align with clinical guidelines, and create unnecessary administrative delays—ultimately contributing to worse patient outcomes.  This study will review documentation of MAOs’ use of prior authorization and step therapy for Part B drugs in selected cases to assess these potential issues.

TIMELINE

• September 15, 2026
  Announced

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