Bills seek to reform Step Therapy requirements


Staff report



COLUMBUS — Senator Peggy Lehner (R-Kettering) and Ohio Senator Charleta Tavares (D-Columbus) have introduced Senate Bill 56, which seeks to address a health insurance industry practice known as “fail first” or “step therapy.” The bill was reintroduced from the last legislative session. Rep. Terry Johnson (R-McDermott) and Rep. Nickie Antonio (D-Lakewood) also introduced a companion bill, House Bill 72.

Step therapy is a cost savings tool used by health insurers that forces patients to take and fail on medications other than what their doctor has prescribed, before their insurer will cover the cost of the original medication. To date, 11 other states have passed laws to reform step therapy practices.

“Ohioans for Step Therapy Reform” is a coalition of 50 patient advocacy and physician organizations that are working together to advocate for the bills and support step therapy reforms.

“For some patients, to fail on a medication could mean serious health setbacks,” said Dr. Shannon Trotter, a Board-Certified Dermatologist in Springfield. “For someone with epilepsy, they could have a seizure; for someone with mental illness, they could have a psychotic episode; for someone with psoriasis, they could endure a prolonged skin rash outbreak; for someone with arthritis, the pain and swelling of joints could persist, to the point of needing surgery; for someone with cancer, the chance of reaching remission or being cured, could be delayed while the cancer worsens. For these serious conditions, and a wide range of other diseases and chronic illnesses, step therapy is often imposed on patients.”

Step therapy protocols can be harmful to patients both financially and physically, causing an undue wait for the proper treatment and in some cases a worsening of a person’s medical condition. Step therapy does not take into account an individual’s medical history or other factors, but instead relies upon a pre-determined prescription drug formulary or protocol.

Senate Bill 56 and House Bill 72 would not ban step therapy, or the number of steps an insurer can implement. The bills require that an insurer’s process for requesting a step therapy override is transparent and available to the provider and patient. The provisions include:

Requiring that an insurer’s process for requesting a step therapy override is transparent and available to the provider and patient.

Allowing automatic exceptions to step therapy requirements when:

  • The required prescription drug is contraindicated or will likely cause an adverse reaction
  • The required prescription drug is expected to be ineffective
  • The patient has previously tried the required drug or a drug in the same pharmacologic class and the drug was ineffective or caused an adverse event
  • The required prescription drug is not in the best interests of the patient based on medical appropriateness
  • The patient is stable on a prescription drug for the medical condition under consideration.

Ensuring that step therapy programs are based on clinical guidelines developed by independent experts.

The following members of the Ohio Senate have also signed on to co-sponsor Senate Bill 56: Bill Beagle (R-Tipp City); Edna Brown (D-Toledo); Joe Schiavoni (D-Boardman); Lou Terhar (R-Green Township); Cecil Thomas (D-Cincinnati); Sandra Williams (D-Cleveland); and Kenny Yuko (D-Richmond Heights).

The following members of the Ohio House of Representatives have also signed on to co-sponsor House Bill 72: Lou Blessing (R-Colerain Township); John Boccieri (D-Poland); Andrew Brenner (R-Powell); Teresa Fedor (D-Toledo); Tim Ginter (R-Salem); Brian Hill (R-Zanesville); Sarah LaTourette (R-Chesterland); and Michael Sheehy (D-Toledo).

More information about fail first/step therapy protocols and its impact on patients is available at www.reformsteptherapy.com and by using the hashtag #FailFirstFeb on Twitter and Facebook.

Staff report

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