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As you may know, one of the key legislative issues VBCF has been working on during the last few Virginia General Assembly sessions is "step therapy." Step therapy - also known as "fail first" - occurs when a doctor prescribes a medication, but the insurance company requires the patient to try one or several other drugs first, usually based on financial, not medical considerations. For cancer patients, step-therapy can mean an unnecessary delay in access to medication, and could cause their health to deteriorate.
HB 2126 puts in place a step therapy exception process that doctors can use when appropriate for their patient. It does not prohibit step therapy but puts clear and fair limits on its usage. For more detail, see fact sheet below.
ACTION NEEDED:
HB 2126 passed the House of Delegates this week and will be considered by the Senate Committee on Commerce and Labor
next Monday, Feburary 11.
If YOUR Senator sits on this committee,
please call their office today to urge them to support HB 2126.
Phone numbers can be found at:
Senate Directory
Members of the Senate Commerce and Labor Committee:
Wagner (Chairman), Saslaw, Norment, Newman, Obenshain, Stuart, Stanley, Cosgrove, Chafin, Dance, Lucas, McDougle, Black, Sturtevant, Spruill
Note: VBCF Advocates have met with the following Senators or their aides during recent years to discuss this issue: Dance, Lucas, McDougle and Sturtevant so they should already be aware of this issue.
Step Therapy Fact Sheet
Cancer Patients Need Transparency and Consistency
Support HB 2126
What is step therapy?
Step therapy- also known as "fail first" - occurs when a doctor prescribes a treatment, but the insurance company requires the patient to try one or several other drugs first usually based on financial, not medical, considerations. The patient must wait for the doctor-prescribed treatment, often for weeks, months or even years, as he or she first tries each of the insurer-mandated drugs one-by-one, and proves that the insurer's preferred treatment didn't work.
Insurers use step therapy to cut down on medication costs, and sometimes the insurer-mandated drugs can even end up working for the patient.
But in some cases, step therapy keeps Virginians living with dangerous and even life-threatening conditions - from mental illness and cancer to epilepsy and autoimmune diseases - from the therapies they need, causing adverse reactions and allowing their health to deteriorate.
House bill 2126 does not prohibit step therapy but rather puts in place an exception process that doctors can utilize when appropriate. It will:
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Ensure that step therapy programs are based on clinical guidelines developed by independent experts;
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Create an exceptions process for step therapy that is efficient, transparent and accessible to patients and health care providers; and
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Establish a basic framework for when it is appropriate to exempt patients from step therapy.
Cancer patients need to be able to quickly obtain exceptions to step therapy if their doctor determines that going through step therapy could threaten their health.
Putting such a clear and fair limit on step therapy may help control system-wide health care costs by helping Virginians obtain the therapies that keep them stable and out of the hospital.
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