FOR IMMEDIATE RELEASE January 7, 2019
Governor Kasich signs step therapy reform
Columbus, OH – Governor John Kasich signed Ohio Senate Bill 265, which will reform how health plans apply step therapy requirements to patients needing certain medications.
Senate Bill 265 included an amendment, introduced by Rep. Scott Lipps (R-Franklin), which was House Bill 72, one of the original step therapy reform bills. House Bill 72 was sponsored by Rep. Terry Johnson (R-McDermott) and Rep. Nickie Antonio (D-Lakewood).
“Patients and medical providers in Ohio thank Gov. Kasich for signing this bill and for protecting patients, “said Christine Jaworsky MD, Ohio Dermatological Association President. “Setting reasonable safeguards on how step therapy is applied in Ohio has been the ultimate goal of more than 60 patient advocacy and medical groups in Ohio. We also thank Sen. Peggy Lehner, Sen. Charleta Tavares, Rep. Terry Johnson, Rep. Nickie Antonio, Rep. Scott Lipps and Rep. Sarah LaTourette for their leadership and hard work to get step therapy reforms finished in Ohio.”
Step therapy is cost management practice increasingly used by health plans. Patients must ‘fail first’ on medicines selected by the health plan, before getting what their doctor originally prescribed. For patients needing a particular medication for their medical condition, unchecked step therapy can cause delays in recovery and wellness.
Provisions in the legislation include:
- Ensure step therapy protocols are based on medical and scientific evidence.
- Provide for a transparent exemptions process for healthcare providers & patients.
- Aligns response timeline for appeals requests with recently enacted prior authorization law.
- Establish circumstances for the prescribing health care provider to override step therapy when medically appropriate for a patient.
As a companion bill to HB 72, Ohio Senate Bill 56 was co-sponsored by Sen. Peggy Lehner (R-Kettering) and Sen. Charleta Tavares (D-Columbus). Both HB 72 and SB 56 were passed unanimously from the House Health Committee and by the Senate Health, Human Services and Medicaid Committee respectively.
Ohio will now join 18 other states that have passed step therapy reforms.
Ohioans for Step Therapy Reform is a coalition of more than 60 patient and medical groups that advocated for the legislation and patient protections.
OHIOANS FOR STEP THERAPY REFORM
Academy of Integrative Pain Management
Academy of Medicine of Cleveland and Northern Ohio
Advocacy Council of the American College of Allergy, Asthma and Immunology
Alliance for Patient Access
American Academy of Dermatology Association
American Academy of Pediatrics Ohio Chapter
American Association of Diabetes Educators
American Cancer Society - Cancer Action Network
American College of Cardiology, Ohio Chapter
American College of Rheumatology
American College of Surgeons, Ohio Chapter
American Diabetes Association
American Lung Association, Ohio and Michigan
Beacon Charitable Pharmacy
Cancer Support Community Central Ohio
Central Ohio Diabetes Association
Chi Eta Phi Sorority, Inc.
Cincinnati Area Senior Services
Coalition of State Rheumatology Organizations
Columbus Chapter Black Nurses Association
Crohn's & Colitis Foundation of America: national, Central Ohio, and Southwest Ohio
Digestive Health Physician’s Association
Global Heathy Living Foundation
Leukemia & Lymphoma Society
Lupus Foundation of America, Greater Ohio
Healing Hearts of Central Ohio
Mended Hearts, National
Mental Health & Addiction Advocacy Coalition
Mental Health America of Franklin County
Myasthenia Gravis Foundation of America, Columbus Support Group
National Alliance on Mental Illness, Ohio
National Kidney Foundation, Central Ohio National Liver Foundation, Heartland Division
National Multiple Sclerosis Society
National Organization for Rare Disorders
National Patient Advocate Foundation
National Psoriasis Foundation
Ohio Academy of Family Physicians
Ohio Asian American Health Coalition
Ohio Association of Advanced Practice Nurses
Ohio Association of County Behavioral Health Authorities
Ohio Association of Rheumatology
Ohio Bleeding Disorders Council
Ohio Chapter National Association of Pediatric Nurses
Ohio Dermatological Association
Ohio Federation for Health Equity and Social Justice
Ohio Foot and Ankle Medical Association
Ohio Hematology Oncology Society
Ohio Nurses Association
Ohio Osteopathic Association
Ohio Pharmacist Association
Ohio Psychiatric Physicians Association
Ohio Sickle Cell and Health Association
Ohio State Medical Association
Prevent Blindness Ohio Affiliate
Public Children Services Association of Ohio
Susan G. Komen Columbus, Northeast Ohio, Northwest Ohio, Southwest Ohio
The Epilepsy Association (serving northeast Ohio)
The Ohio Council of Behavioral Health & Family Services Providers
U.S. Pain Foundation
The Columbus Dispatch
Bill would streamline prescription relief for patients
By Catherine Candisky The Columbus Dispatch Nov 13, 2018
Physicians and patient advocates are pushing during the final weeks of the legislative session for passage of a bill they say would shorten ailing Ohioans’ wait for their doctor’s first choice of medication.
The bill targets a practice called step therapy, which is used by insurers to control prescription-drug costs by requiring patients to use cheaper drugs first. If those don’t work, the patients can try more-expensive medicine prescribed by their doctor.
Supporters of the bill say the pursuit of lower drug prices is putting patients’ lives at risk by delaying treatment, often causing complications and added costs.
Health insurers and other critics argue that the legislation would increase health care costs for consumers, employers and the state, which operates the tax-funded Medicaid program.
At a Statehouse press conference Tuesday, state Sen. Peggy Lehner, R-Kettering, who is one of the bill’s sponsors, said, “This bill is not about eliminating step therapy. Step therapy is a perfectly valid way to control costs and make sure patients have a drug that works for them.”
“However, there are exceptions to the rules, and this bill is about making sure that some of those exceptions are in the law so that patients not only have the most cost-effective drug, but they also have the most medically effective one.”
State Rep. Scott Lipps, R-Franklin, knows firsthand how someone can see their health deteriorate when forced to try a cheaper medication.
“About a year ago, I grew ill ... and in November received an uncomfortable diagnosis, but I really trusted my specialist. I’d known him my whole life. I went to the pharmacy to pick up my first prescription, and the pharmacist said, ‘You can’t have that, Scott. It was denied by your insurance company,’” Lipps said.
“After 60 days with a horrible side effect and absolutely no impact on my tumor, I raised a lot of hell” and won approval of the doctor’s recommended medication. “Within 14 days, I saw a dramatic reversal of my condition. I’d lost about 50 pounds. I had an immediate stop of the loss of weight and gained a few pounds back. I started feeling better. I started looking better. I started living again. No side effects.”
After discussing his experience, Lipps didn’t disclose his condition but said he’s “successfully battling an illness.”
Senate Bill 56 and the identical House Bill 72 would streamline the process patients must follow to override “fail first” requirements when their doctor says a medicine is needed for their health. Health insurers also would have to respond to requests for step-therapy exemptions within 72 hours, and, under some circumstances, within 24 hours.
The current process can be lengthy. Stephanie McCarroll, a nurse at Cleveland Clinic’s Asthma Center, said she spent “two hours, seven minutes and 58 seconds on the phone” with insurers after switching a patient’s medication from one that wasn’t working to one that did.
Supporters have been pushing for the legislation for four years and are urging legislators to approve the measure before adjourning in December. Eighteen states have enacted similar bills.
Opponents, including the Ohio Association of Health Plans, say the legislation would be an unfunded mandate on health insurers and drive up prescription costs.
“We oppose legislative mandates that hinder pharmacy benefit managers’ ability to reduce costs and improve the quality of pharmacy benefits,” said Greg Lopes, spokesman for the Pharmaceutical Care Management Association. “Step therapy is a valuable tool to ensure patients get the most clinically appropriate and affordable treatment possible. Employers, unions, and public programs use tools like step therapy and prior authorization in their pharmacy benefits in order to reduce inappropriate drug use, lower costs and improve quality.”