Twenty-five attendees representing 15 coalition partners including the Ohio Academy of Family Physicians represented by OAFP Past President Sarah Sams, MD, attended the Ohio Step Therapy Advocacy Day held November 13 at the Statehouse.
The advocacy day included a press conference and distribution of information packets to 124 legislators urging a yes vote on Senate Bill (SB) 56 and House Bill (HB) 72, bills that would reform step therapy practice by insurers.
During the press conference, Dr. Sams provided specific examples about how her patients and their health care were negatively impacted by the step therapy practices utilized by health insurance plans.
- Ensure step therapy protocols are based on medical and scientific evidence
- Provide for a transparent exemptions process for health care providers and patients
- Align response timeline for appeals requests with the prior authorization law
- Establish circumstances for the prescribing health care provider to override step therapy when medically appropriate for a patient.
HB 72 is currently in the House Health Committee, where a second substitute version was accepted back in late June. SB 72 is in the Senate Health, Human Services, and Medicaid Committee, where it, too, has had two substitute versions accepted.
The OAFP strongly supports step therapy reform legislation as a means for achieving administrative simplification in health care.
Health insurers, however, oppose the legislation. They note patients are grouped together in insurance pools, and the costs of the more expensive drugs will be passed on to everyone if the legislation passes. Prescriptions currently account for 23 cents of each dollar people pay on their premiums. Ohio Medicaid has cautioned the legislation could cost the state tens of millions of dollars a year.
According to bill sponsor Senator Peggy Lehner (R-Dayton, OH), 18 states have already passed similar “patient protection laws” on step therapy and none have reported major price hikes.