New Law Helps Wisconsin Patients Navigate Step Therapy Protocols
Patients To Receive the Right Treatment at the Right Time
Portland, Ore. (July 9, 2019)—The National Psoriasis Foundation, NPF, in coalition with more than 30 patient and provider advocacy organizations praise Governor Tony Evers (D) and Wisconsin lawmakers for passing S.B. 26, legislation that requires patient protections for step therapy protocols in state-regulated, individual insurance plans.
This new law directly impacts a patient’s ability to get the treatment that their health care provider knows is right for them. Starting January 1, 2020, when an insurer, pharmacy benefit manager, or utilization review organization establishes a step therapy protocol, it must be based on clinical practice guidelines. Additionally, a clear and expeditious exceptions request process must be easily accessible when a plan restricts prescription drug coverage. Upon a patient appeal, insurers are required to reply within one business day for emergency exception requests, or three 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 Angie Thies, state government relations manager, NPF. “It is critical that the patient provider relationship is preserved, and patients receive the treatments their health care provider knows is best for managing their disease.”
Currently, the estimated 146,053 Wisconsin residents living with psoriasis or psoriatic arthritis may be subjected to step therapy or ”fail-first” policies. Insurance providers often use these policies to evaluate medication options for specific conditions and to contain costs. 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.
"The passage of this law will help Wisconsinites facing psoriasis and psoriatic arthritis have an easier time getting the medication they need,” said Dr. Lisa Arkin, director of pediatric dermatology, University of Wisconsin School of Public Health. “Patients will no longer have to fail first or take ineffective medications before being approved for the medication their provider prescribes.”
Sponsored by Senators Alberta Darling (R) and Andre’ Jacque (R) and Representatives John Nygren (R) and Loren Oldenburg (R) the new law will apply to health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2020.
NPF led a broad-based coalition of more than 30 organizations, ensuring the patient’s voice was central and elevated throughout an advocacy day, testimony of patients and providers during a rare, joint committee of Senate and Assembly Health committees and in legislative meetings with the Wisconsin Assembly, Senate, and the Governor’s office.
The adoption of this law is an important milestone for patients in Wisconsin. It represents the first patient access issue to pass the Wisconsin legislature in approximately five years and is a testament to the bipartisan support for addressing health care concerns in the state.
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.