Georgia Passes New Step Therapy Law Protecting Over 250,000 Psoriatic Disease Patients
National Psoriasis Foundation Joins Rx in Reach Georgia Coalition to Pass New Law
This new law directly impacts a patient’s ability to get the treatment that is right for them by expanding access to care. H.B. 63 requires step therapy protocols be evidence-based and up-to-date with a clear and expeditious exceptions request process. The process must be easily accessible when an insurance plan restricts prescription drug coverage. Insurers are also required to reply within 24-hours for emergency exception requests, or two business days for non-emergency exception requests.
Patients will be granted an exception 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 required treatment and it was discontinued due to lack of efficacy, or the patient is receiving a positive outcome with their current treatment.
“We are extremely proud of the work this coalition has done to put the patient’s best interest first when it comes to treatment,” said Amy Prentice, associate director, state government relations, NPF. “Having a law and process in place that ensures patients are given the most appropriate treatment for their disease, is a critical step in providing patients the very best options for a healthy outcome.”
Currently, the estimated 256,489 Georgia residents living with psoriasis or psoriatic arthritis may be subjected to step therapy or ”fail-first” policies. Insurance providers use these policies to evaluate the medical necessity or appropriateness of the medication for the condition. Unfortunately, these policies require that individuals fail on at least one therapy before they are granted approval for the medication their doctor initially prescribes, which can result in significant delays of treatment, risk for loss of function, increased disease activity and potentially irreversible disease progression or disability.
"As an advocate that has experienced step therapy first-hand, the passage of this bill will benefit so many people with psoriatic disease,” said NPF Patient Advocate Cheryl Gentile. “This bill will provide quicker access to effective treatments prescribed by their health care provider and not have to fail first on treatments required by their insurance company."
Sponsored by Representative Sharon Cooper (R) District 43 and co-sponsored by Richard Smith (R) District 134, Deborah Silcox,(R) District 52, Lee Hawkins (R) District 27, Mike Wilensky (D) District 79, and Angelika Kausche (D) District 50, the new law will apply to health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2020.
Working in coalition with 36 organizations, NPF participated in a patient advocacy day to educate lawmakers on what it is like to be subjected to step therapy and worked with patient advocates to contact their lawmakers asking for support. The adoption of this law is an important milestone for patients in Georgia, as well as 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.