09/21/2017

Ohio patient advocates push to reform step therapy

Representing the Ohio Psychiatric Physicians Association, Executive Director, Janet Shaw, was one of more than 40 advocates who gathered at the Ohio Statehouse on Sept. 20 to push legislation that would reform "step therapy" also known as "fail first" practices.  

The OPPA is one of the 60 organizations in Ohio's Step Therapy Coalition that support Senate Bill 56, sponsored by Sens. Peggy Lehner (R-Kettering) and Charleta Tavares (D-Columbus), and companion House Bill 72 sponsored by Reps. Terry Johnson (R-McDermott ) and Nikkie Antonio (D-Lakewood). 

According to the coalition, "Step therapy is a cost management tool utilized by health plans where patients must first take, then fail, one or more prescription medications deemed to be at less cost than a drug originally prescribed by their physician.

The legislation will give doctors a transparent and standardized process to appeal step therapy requirements for patients needing a particular treatment. The bills do not mandate that insurers cover any medications that are not already part of a patient's coverage. 

The advocates met with lawmakers to explain what the bills do (and don't do) and to ask for their support of SB56/HB72 which will improve the step therapy process by:

• 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 by the treating physician 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 interest of the patient based on medical appropriateness; or
  • 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.

Currently 15 other states have passed laws that reform step therapy practices. Ohio is among eight states now considering step therapy reforms.

In addition to state legislation, Ohio Congressional lawmaker Rep. Brad Wenstrup (R-OH) and Rep. Raul Ruiz (D-CA) introduced "The Restoring the Patient’s Voice Act," which seeks step therapy reforms at the federal level. 

More information about fail first/step therapy protocols and its affect on patients is available at http://www.reformsteptherapy.com/ and on Twitter and Facebook.