Aimed Alliance and three other patient advocacy groups sent a letter to Excellus BCBS, a New York insurer, expressing our concerns over its prior authorization and step therapy policy for non-small cell lung cancer (NSCLC) treatments, which it adopted midyear. The new policy effectively excludes at least one medication from coverage. Patients with advanced NSCLC whose tumors have high programmed death-ligand 1 (PD-L1) expression must first demonstrate a proven contraindication to two other medications. Yet, the two medications have no contraindications listed on their labeling, meaning patients must try and fail on them. If they try and fail on those medications, the policy will not cover any other medications within the same class. Therefore, the policy excludes the third medication from coverage. The new policy is also inconsistent with NCCN guidelines.
The groups have asked Excellus to amend its prior authorization policy to remove the prior authorization and step therapy requirements for patients with advanced NSCLC whose tumors have high PD-L1 expression. Read our letter here.