Senators Peggy Lehner (R-Kettering) and Charleta Tavares (D-Columbus) introduced Senate Bill 56 which would put into place protocols for insurance companies that utilize step therapy (also known as fail first).
Step therapy is a cost savings tool used by health insurers to limit how much they spend covering patient's medications. Under step therapy, a patient must try one or more medications chosen by their insurer - usually based on financial, not clinical, considerations - before coverage is granted for the medication prescribed by the patient's physician.
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.
Step therapy undermines what physicians believe is the best treatment for patients based on their knowledge of the patient's overall health and ability to tolerate certain medications.
While S.B. 56 does not do away with step therapy all together, it puts into place patient protections, including:
S.B. 56 is scheduled for sponsor testimony in the Senate Health, Human Services and Medicaid committee on Tues., Feb. 21.
The OPPA has taken a position of Active Support with Technical Assistance.