STEP THERAPY (H 4929)

By Bob Katzen

Governor Charlie Baker signed into law a bill that limits the use of health care plan mandated prescription drug “step therapy” protocols and provides more exemptions to the mandate. Step therapy requires the patient to try less expensive options before “stepping up” to drugs that cost more. Conditions which would exempt a patient from trying the less expensive drug first include if the treatment will harm the patient, or if the patient previously tried the required treatment, or similar treatment, and it was ineffective.

Supporters said that insurers that utilize step therapy protocols require medical providers to prescribe lower-cost medications to patients first, and only grant approval for alternative medications when the cheaper options have failed to improve a patient’s condition. This results in insurers effectively choosing medications for the patient, even in cases where their providers have recommended an alternative. When patients change insurers, they are often forced to start at the beginning of the step therapy protocol again, which results in wasteful health care expenditures, lost time for patients and potentially devastating health care impacts on the patient.
“On behalf of the dozens of patient groups who worked so hard on this issue, we are thrilled that Gov. Baker has signed it into law,” said Marc Hymovitz, Government Relations Director in Massachusetts for the American Cancer Society Cancer Action Network. “This law puts treatment decisions back in the hands of doctors and patients where it belongs. It ensures patients will get the necessary medicine in a timely manner. Without a doubt, this will have a positive impact on thousands of patients across the commonwealth.”
“We are taking action to ensure that patients with complicated illnesses receive the medications that their doctors know they need—not repeatedly taking medications that are ineffective,” said sponsor Sen. Julian Cyr (D-Truro), Senate chair of Committee on Mental Health, Substance Abuse and Recovery. “Waiting for treatment to fail first before utilizing a preferred medication often leads to worsening symptoms that cause complications and needless suffering for patients. It is a shortsighted practice that puts patients at unnecessary risk.”
“This bill is a major step forward in ensuring patients and doctors have access to the right medication at the right time,” said Sen. Cindy Friedman (D-Arlington), Senate chair of the Committee on Health Care Financing. “We are finally joining over half the states in the nation in reforming step therapy practices, putting the focus back on health care providers working with patients to offer the best treatment possible.”
The governor’s office did not respond to repeated attempts by Beacon Hill Roll Call to get the governor to comment on the new law/

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