In 2020, three states passed bi-partisan step therapy reform legislation, demonstrating that access to care issues need to be addressed, even during a pandemic. Advocating from afar, patients in South Dakota, Louisiana and North Carolina successfully made the case for step therapy protections that honor the patient-doctor relationship and ensure timely access to care.
Step therapy is an insurance protocol that requires patients to try and fail drugs selected by their insurance company before the treatment prescribed by their doctor is covered. NPF works to pass patient protections for step therapy because it delays access to care for people with psoriatic disease. In fact, a 2019 survey of people with psoriasis and psoriatic arthritis found that 41 percent have experienced step therapy.
This year, South Dakota and North Carolina joined over two dozen states in passing step therapy reform legislation. The Louisiana Legislature strengthened its step therapy law to become one of the strongest patient bills in the U.S.
Leading in South Dakota
In South Dakota, NPF led the patient and provider coalition’s effort to pass Senate Bill 155. This effort was successful because the patient and provider voice was front-and-center during meetings with policymakers to explain how the bill would strengthen the patient-doctor relationship and improve health care access for patients with psoriatic disease and other chronic diseases. South Dakota NPF patient advocate, Gay Murphy, wrote to her representative stating, “My heart breaks for those patients facing [step therapy] delays[…] It has been a long, hard fight to find and be successful with the treatment my doctor and I have agreed on. That is why […] I really believe the doctor and the patient need to be the principle players in finding a treatment. Serious, hard-to-treat psoriasis, or other chronic disease, is exhausting enough without an extra step.”
Senate Bill 155, which passed unanimously and was signed into law by Governor Noem in March 2020, requires health insurance plans to:
- Provide a clear, accessible and convenient step therapy exceptions process
- Reply within 72-hours for emergency exception requests, or five business days for non-emergency exception requests
- Automatically grant exceptions if an exception request is not granted or denied within these timeframes
Among other provisions, the new law also provides specific language regarding when an exception request must be granted
Strengthening Protections in Louisiana
The new law in Louisiana builds on existing step therapy protections originally passed in 2010. NPF volunteer advocate, Debra Mike, explained in a letter to legislators that going through the step therapy process was the driving force behind her advocacy voice, as she was currently being stepped for a biologic to treat her severe psoriasis. In advocating for House Bill 263, Debra said, “Everyone knows me as someone who does NOT give up easily. If I believe in something, I go wholeheartedly into it. [HB 263] is VERY near and dear to my heart/health, so I will do all that I can.”
On June 12, 2020, Governor Edwards signed HB 263 into law. It requires insurers to provide a clear process for submitting an exception request to the step therapy protocol if medical documentation supports one of the five exception standards in law. Further, insurers are required to reply within 24-hours for emergency exception requests, or 72-hours for non-emergency exception requests. If an exception request is not granted or denied within these timeframes, the exception will automatically be granted.
A Long Journey to Victory in North Carolina
The passage of step therapy protections in North Carolina was five years in the making. Since 2015, NPF has worked with a coalition of patient and provider organizations as well as dedicated advocates to meet with lawmakers and testify in support of step therapy reforms. These advocates included P.J. Leary and Brian Lehrschall. This steadfast multi-year effort led to the passage of Senate Bill 361 in July. “The passing of this bill is validation that five years of hard work has paid off,” said Lehrschall, co-chair of NPF’s Eastern Advocacy Action Network, in a press release. “I know our efforts were worth it as this new law will have a positive impact on the lives of many people living with chronic diseases throughout North Carolina, and for that I am extremely proud." Unfortunately, P.J. Leary passed away in 2016, before meaningful step therapy reform was passed in North Carolina.
On July 1, Governor Cooper signed S.B. 361 into law, which requires insurers to provide a clear process for submitting an exception request to step therapy protocols if the required treatment will likely cause an adverse reaction, is expected to be ineffective, or if the patient has previously tried it. Insurers are required to respond to a step therapy exceptions request within 72 hours, or 24 hours in the case of an urgent request.
NPF will continue to elevate the patient voice and move the needle for better access to care during the pandemic and beyond, because it is of the utmost importance that unnecessary barriers to appropriate treatments are removed for people with psoriatic disease.
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