Advocates from the Fair Health Care Virginia Coalition announced their support for new legislation in Virginia to improve an insurance requirement known as step therapy, or “fail first” protocols.
House Bill 2126, introduced by Republican Del. Glenn Davis, would rein in this insurance practice and help protect patient access to the care they need.
“Patients should have access to the full range of care they need, not just what happens to be the cheapest option available,” said Tom Ema, a patient advocate with the Coalition. “I tried and failed three times on the same chemotherapy for my stage 4 lymphoma. But for the hard work of my doctor, rather than receiving the cure that resulted in my first cancer-free scan in 20 years, I would be trying, and failing, for a fourth time.”
Under step therapy, patients must try and fail on older, often less expansive treatments before they can receive the medication their doctor originally prescribed in order to save money for insurance companies. Particularly for patients with chronic or complex conditions, this can result in a loss of disease control as well as serious consequences and side effects from treatments their doctors know are unlikely to be effective.
“Too many patients across Virginia have their own story to tell about how they were impacted by step therapy, often being denied effective care for their chronic, complex conditions. For me, step therapy is personal. My wife experienced it a few years ago, and ever since I learned how impactful and misunderstood it can be, I’ve been fighting to make a change,” said Delegate Glenn Davis, lead sponsor of House Bill 2126. “I’m proud to have introduced new legislation, House Bill 2126, that would help improve the step therapy process to ensure patients can get the care they need while adding much-needed transparency to the equation.”
Nearly 20 states across the country have already taken legislative action to rein in the practice of step therapy. The proposed legislation would not outlaw step therapy all together. Instead, it would establish standards where a patient could avoid undergoing step therapy when their medical provider knows it would be harmful.
“With the current emphasis on patient-centered care, shared decision-making and personalized medicine, improvements to step therapy, such as expediting the exception process and allowing patients to remain on medications that are successfully managing their illnesses, improves lives while also saving money,” said Dr. Harry Gewanter, a pediatric rheumatologist and the Advocacy Chair of the Arthritis Foundation Virginia chapter. “Step therapy protocols utilize a one-size-fits-all process which can be inappropriate for some patients, including those with chronic and complex conditions, who need to work with their providers to construct unique treatment plans.”
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