Yes: Patients shouldn’t face needless waits for needed drugs

While waiting for his health plan to allow him to have his prescribed medication, my colleague in the Ohio General Assembly saw his health deteriorate.

The health plan required Rep. Scott Lipps, R-franklin, to “fail first” on its chosen drug, over what Scott’s own physician thought would be best for his particular condition. The process is called “step therapy” and it happens to many other Ohioans, some of whom also experience a health setback while waiting for the health plan to accept the doctor’s original prescription.

While step therapy can be a useful costmanagement tool, it is increasingly becoming a “one-size-fits-all” approach to medication. This is why Ohio legislators are working to reform — not ban — step therapy in Ohio.

Along with my colleague Sen. Charleta Tavares, D-columbus, I am sponsoring Senate Bill 56, which would provide patient protections when step therapy is required. Provisions in the legislation include:

• Ensure step-therapy protocols are based on medical and scientific evidence.

• Provide for a transparent exemptions process for health-care providers and patients.

• Establish circumstances for the prescribing health-care provider to override step therapy when medically appropriate for a patient.

This week, the Senate Health, Human Services and Medicaid Committee unanimously voted to support Senate Bill 56. A companion bill in the Ohio House also received unanimous support in the House Health Committee. That both committees supported this bill with full support is significant. Senate Bill 56 will now go to the Senate floor for a full vote and then on to the House of Representatives.

The Ohio Association of Health Plans opposes reasonable reforms to step therapy in Ohio. They argue that cost-management methods such as step therapy are needed to bring down the cost of drugs. I agree. So do many physicians, who already prescribe with step therapy in mind. Doctors prescribe medication that they think will work best for a patient.

In these days of personalized medicine, however, sometimes a particular medication is needed. Step therapy should not be a barrier to a patient’s ability to improve, as quickly as possible.

Health plans have increased their use of step therapy. In 2010, nearly 60 percent of commercial insurers were using the technique. As of 2013, 75 percent of large employers reported offering employees plans that utilize step therapy, according to the Journal of Managed Care.

Eighteen other states already have passed laws to reform step therapy. It is important to note the cost to the state, which the OAHP has argued would be high. Of the 15 states that have implemented a law, none has done an analysis that shows actual costs incurred as a result of the legislation.

Of the nine states that produced fiscal evaluations:

• Iowa, Minnesota and Texas determined there would be no significant fiscal impact;

• Ohio, New Mexico, and Maine concluded that there was not enough information to determine any longterm fiscal impact; and

• Utah, Indiana, and Missouri estimated that there could be a net impact for the state depending on how any costs would be financed.

Ohioans for Step Therapy Reform is a coalition of more than 60 groups representing patients with cancer, mental illness, multiple sclerosis, Crohn’s disease, colitis, diabetes, arthritis, epilepsy, psoriasis and more. Since 2015, these advocates have been diligently working to educate lawmakers about the impact of unchecked step therapy.

At a recent Statehouse news conference, we heard many examples of real patients dealing with step therapy.

• An asthma patient in Cleveland with a severe flare-up was told it would take 30 days for the health plan to decide whether to allow the inhaler that worked best.

• A stroke patient who was stable on multiple blood-pressure medications for nine years, was required by step therapy to try a different medication.

Unchecked step therapy can cause disease progression, increased visits to the emergency department and hospitalization. “Fail first” requirements can hurt patients and drive up costs in the system. It’s time for Ohio to place reasonable reforms on step therapy.

Peggy Lehner is a Kettering Republican who represents the 6th District of the Ohio Senate.