Patient Groups Make the Case for Step Therapy Reform in Ohio

HB 72 will help patients get the treatments their doctors want them to have

(April 11, 2018) – Doctors, not insurers, should be advising patients on the best treatments for what ails them.  This was the powerful message brought by patients, advocates and medical professionals during a hearing today on Ohio House Bill 72 during the Health Committee hearing at the Ohio House of Representatives.

“Excluding physicians’ clinical judgment from patients’ treatment plans creates a barrier to getting the right care at the right time,” said Scott Bruun, executive director of the Chronic Disease Coalition in his testimony. “Step therapy can undermine physicians’ ability to effectively treat patients and can reduce the quality of care, resulting in set-backs and disease progression for patients. In this regard, step therapy results in even more expenses rather than containing them – another reason we urge you to support this reform.”

Julie McMahon, Director of Mission with Susan G. Komen Columbus said in her testimony, “Unfortunately, most step therapy protocols rely on generalized information regarding patients and their treatments as opposed to taking into account unique patient experiences and responses to different treatments. This disjointed system has created a barrier for patients in accessing timely and appropriate treatments”

House Bill 72 is co-sponsored by Reps. Terry Johnson, DO (R-McDermott) and Nickie Antonio (D-Lakewood) The bill seeks to reform a health insurance industry practice known as “fail first” or “step therapy,” which requires a patient to try medications other than what was originally prescribed by a physician.  The legislation would reform step therapy practices, to ensure patients are getting treatments as determined by their doctor. The Legislative Service Commission has opined that House Bill 72 is not considered a mandate.   Provisions in the legislation include:

  • Ensures step therapy protocols be implemented via clinical review criteria that are based on clinical practice guidelines or medical or scientific evidence.
  • Provides for a transparent exemptions process for healthcare providers & patients.
  • Aligns response timeline for appeals requests with recently enacted prior authorization law.
  • Establishes circumstances for the prescribing health care provider to override step therapy when medically appropriate for a patient.

“Step therapy was created to limit how much insurers spend covering patients’ medications, but it has evolved into a one-size-fits-all policy,” said Dr. Stephanie Ott, who offered testimony as president of the Ohio Association on Rheumatology.  “For many physicians and patients it has become a significant barrier to getting the right care at the right time.”

The following organizations offered proponent testimony to the House Health Committee:

Academy of Integrative Pain Management

Academy of Medicine of Cleveland and Northern Ohio

American Academy of Dermatology Association

American Diabetes Association

American Lung Association Ohio

Chronic Disease Coalition

Mended Hearts, Inc.

Mental Health Addiction and Advocacy Coalition

Mental Health America of Franklin County

National Multiple Sclerosis Society

National Organization of Rare Disorders

National Patient Advocacy Foundation

Ohio Association of Rheumatology

Ohio Dermatology Association

Ohio Federation for Health Equity and Social Justice

Ohio Foot and Ankle Medical Association

Susan G. Komen Columbus, Northeast Ohio, Northwest Ohio, Southwest Ohio

Toledo Allergy Society

US Pain Foundation

National Psoriasis Foundation

Ohio Bleeding Disorders Council

Ohio Psychiatric Physicians Association

Crohn’s and Colitis Foundation

Printer-Friendly Version