Senate Health Committee Chair Senator Dave Burke (R-Marysville, OH) has indicated a possible vote may be scheduled this week on Substitute Senate Bill (SB) 56, the step therapy reform bill that the Ohio Academy of Family Physicians has long supported. Sarah Sams, MD, vice chair of the OAFP Public Policy Committee, has testified in support of the legislation in behalf of the OAFP.
The bipartisan legislation, sponsored by Senators Peggy Lehner-R and Charleta Tavares-D, will provide patients timely access to the medications they need. SB 56 improves step therapy protocols, a one-size-fits-all utilization management tool used by health insurance plans, which require patients to try and fail one or more prescription drugs before coverage is provided for the medication chosen by the patient’s health care provider.
The step therapy algorithm requirements do not take into account the physician’s clinical judgement as well as the patient’s personal medical history. Excluding physicians’ clinical judgment from patients’ treatment plans creates a barrier to getting the right care at the right time. Step therapy can undermine physicians’ ability to effectively treat patients and lower quality of care, resulting in set-backs and disease progression for patients.
Negotiations over a substitute bill have occurred over the past several weeks, and as a result the committee is expected to adopt a substitute bill on May 22. The substitute bill will contain four exemptions as follows: contraindicated; patient has tried the required drug; required drug is not in the best interest of the patient; and the patient is stable. The bill also includes clarifying language to state that the exemption request or the appeal shall be deemed granted if the health plan does not respond within the prescribed time frames.
If enacted, Ohio would join a list of 17 states that have enacted similar step therapy legislation, including Indiana, West Virginia, Iowa, Arkansas, Louisiana, New Mexico, Texas, and Minnesota.