This week, a bill I authored with State Representative John Nygren to reform step therapy received unanimous support from two committees. Both the Senate Committee on Health and Human Services and the Assembly Committee on Health approved the bill unanimously.
In an attempt to lower costs, patients are often required to go through what is called "step therapy." Patients are forced to try a drug or a therapy that their doctor didn't prescribe. Unfortunately, step therapy often ignores a patient's medical history and creates red tape that blocks patients from receiving the best healthcare for them.
While insurers often have an exemption process from step therapy protocols, it can be unclear and results in an unnecessary back and forth between the patient, doctor, and insurance company; all of which delays care.
Our legislation creates common-sense exemptions for step therapy:
- The patient already tried the drug and it failed.
- The required drug is expected to be ineffective based on the known clinical characteristics of the patient and the known characteristics of the prescription drug regimen.
- The patient is stable on a prescription drug selected by their health care provider for the medical condition under consideration while on their current or previous health insurance or health benefit plan.
- The required prescription drug is contraindicated or will likely cause an adverse reaction by or physical or mental harm to the patient.
With unanimous support from two committees, it is my hope our step therapy bill will be voted on by both houses soon.
