Delaware Expands Patient Protections with New Step Therapy Law
H.B. 105 Provides Access to the Right Medication at the Right Time
Portland, Ore. (June 18, 2019)—The National Psoriasis Foundation, NPF, in coalition with 13 other patient and advocacy organizations applaud Governor John Carney and Delaware lawmakers for passing H.B. 105 into law. Now, the 24,500 Delawareans living with psoriasis and psoriatic arthritis will be able to receive the medications that their health care providers prescribed without having to experience step therapy protocols.
Currently, individuals living with diseases such as psoriasis or psoriatic arthritis may be subjected to step therapy or ”fail first policies”. These policies are mechanisms insurance providers use to evaluate the medical necessity or appropriateness of a medication for a specific condition. Step therapy typically requires that individuals try and fail on at least one therapy before being granted approval for the medication that their health care provider initially prescribed. This process often results in patients experiencing significant delays in treatment, placing the individual at risk for loss of function, increased disease activity and potentially irreversible disease progression or disability.
H.B. 105 ensures that step therapy protocols are based on appropriate clinical practice guidelines or published peer review data developed by independent experts with knowledge of the condition under consideration. The new law requires a clear and convenient exceptions process must be made easily accessible via the insurer’s, health plan’s, or utilization review entity’s website, and that insurers are required to reply within 24-hours for emergency exception requests, or two business days for non-emergency exception requests.
Patients will be granted exceptions if: treatments are contraindicated or will likely cause an adverse reaction or harm to the patient, treatments are expected to be ineffective, the patient has already tried the treatment and it was discontinued due to lack of efficacy, the treatment is not in the best interest of the patient, or the patient is stable on their current treatment.
“Psoriasis and psoriatic arthritis are challenging diseases to treat, there is no one medication that will work for everyone. That is why it is critical for patients to find and stay on a treatment that works for them,” said Amy Prentice, associate director, state government relations, NPF. “H.B. 105 gives patients the ability to bypass step therapy policies and receive the treatment their health care provider determines is most appropriate for managing their disease and preserving their overall quality of life."
Sponsored by Representative Melissa Minor-Brown (D), Senator David B. McBride (D), and Senator Nicole Poore (D), and co-sponsored by Senators: Stephanie L Hansen (D), Trey Charles Paradee (D), Brian Pettyjohn (R), David P. Sokola (D) and Bryan Townsend (D). As well as Representatives: Paul S. Baumbach (D), Andria L. Bennett (D), David Bentz (D), Stephanie T. Bolden (D), Gerald L. Brady (D), Ruth Briggs King (R), Franklin D. Cooke (D), Sherry Dorsey Walker (D), Debra Heffernan (D), Kendra Johnson (D), John A. Kowalko (D), Valerie Longhurst (D), Sean Matthews (D), Edward S. Osienski (D), John J. Viola (D), and Kimberly Williams (D).
Unanimously passed in both the House and Senate, the new law will begin nine months after signature and will be applicable to plans issued on or after that date.
NPF supported this law by participating in a broad-based coalition with 13 other organizations led by the Arthritis Foundation. Additionally, NPF testified in support of the legislation and worked with patient advocates to contact their lawmakers asking for support. The adoption of this law is an important milestone for patients in Delaware, and for NPF efforts to ensure patients have timely access to the most appropriate treatments to manage their disease.
NPF continues to work on behalf of all patients living with psoriasis or psoriatic arthritis that cannot afford to delay access to the effective treatments prescribed by their health care provider. Placing patient protections around step therapy protocols will assist NPF to improve health outcomes for the more than 8 million Americans living with psoriasis and psoriatic arthritis. To learn more about how NPF works to reform step therapy visit www.steptherapy.com
About the National Psoriasis Foundation
Serving its community through more than 50 years of patient support, advocacy, research funding, and education, the National Psoriasis Foundation (NPF) is the world’s leading nonprofit fighting for individuals with psoriasis and psoriatic arthritis. The NPF mission is to drive efforts to cure psoriatic disease and dramatically improve the lives of more than 8 million Americans affected by this chronic immune-mediated disease. As part of that effort, NPF created its Patient Navigation Center to offer personalized assistance to everyone with psoriasis or psoriatic arthritis. To date, NPF has funded more than $21 million in research grants and fellowships that help drive discoveries that may lead to more and better treatments and ultimately a cure. Learn more at www.psoriasis.org.