Senate Health Committee Chairman Dave Burke (R-Marysville, OH) prepared additional amendments to Senate Bill (SB) 56, which will be the vehicle for moving step therapy reform legislation forward in the lame duck session. The House is expected to create a companion bill to the legislation in the Senate. To date, there have been 21 different versions of SB 56 and four versions of House Bill 72.
- The required drug is contraindicated for that specific patient, pursuant to the drug’s FDA’s prescribing information.
- The patient has tried the required prescription drug while under their current, or a previous, health benefit plan, or another FDA approved AB-rated prescription drug, and such prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event.
- The patient is stable on a prescription drug selected by their physician or other health care professional for the medical condition under consideration, regardless of whether or not the drug was prescribed when the patient was covered under the current or a previous health benefit plan.
The amended bill allows a health benefit plan to require a stable patient to try a pharmaceutical alternative, per the FDA’s orange book, purple book, or their successors, prior to providing coverage for the branded drug.
At the request of the Ohio Department of Insurance, the “best interest of the patient” exemption has been removed from the latest version of the bill. That exemption stated the required prescription drug is not in the best interest of the patient, consistent with medical or scientific evidence, and the physician or other health care professional documents the specific reason for the step therapy exemption in the patient’s medical record.
The Ohio Department of Medicaid, once opposed to the bill, now states that this version of the bill would have a minimal fiscal impact to the state Medicaid program. The bill also requires, no later than 90 days after the bill’s effective date, the Medicaid director submit to the U.S. Secretary of Health and Human Services a Medicaid state plan amendment as necessary for the bill’s implementation.
The Ohio Academy of Family Physicians strongly supports step therapy reform and hopes that some version of the bill can be voted out of the Senate and House and sent to the Governor before the end of this General Assembly.