On February 2, House Bill 443 (HB 443), sponsored by Representative Terry Johnson (R-McDermott, OH) was introduced into the Ohio House of Representatives for consideration. HB 443 is a companion bill to Senate Bill 243 (SB 243), a proposal that seeks to minimize barriers to treatment by improving the step therapy process. At its meeting on January 24, the Ohio Academy of Family Physicians Board of Directors voted to strongly support SB 243.
Step therapy is a tool insurers use to limit how much they spend covering patients’ medications. Under step therapy, a patient must try one or more drugs chosen by their insurer – usually based on financial, not medical, considerations – before coverage is granted for the drug prescribed by the patient’s physician. Patients may be required to try one or more alternative prescription drugs that are of lower cost to the insurer, but may not be the best therapy for some patients.
- Requiring that an insurer’s process for requesting a step therapy override is transparent and available to the physician and patient
- Allowing automatic exceptions to step therapy requirements when:
- The required prescription drug is contraindicated or will likely cause an adverse reaction
- The required prescription drug is expected to be ineffective
- The patient has previously tried the required drug or a drug in the same pharmacologic class and the drug was ineffective or caused an adverse event
- The required prescription drug is not in the best interest of the patient based on medical appropriateness
- The patient is stable on a prescription drug for the medical condition under consideration.
- Ensuring that step therapy programs are based on clinical guidelines developed by independent experts.