New Maine Law Protects 35,000 Psoriatic Disease Patients
L.D. 1009 Provides Protections for Maine Patients Facing Step Therapy.
Portland, Ore. (June 14, 2019)—The National Psoriasis Foundation, NPF, supports Governor Janet Mills and Maine lawmakers in the passage of L.D. 1009 – An Act To Provide Protections for Maine Patients Facing Step Therapy. This new law will assist Maine residents living with diseases such as psoriasis and psoriatic arthritis receive the medications that their health care providers prescribe in an expeditious manner.
Currently, patients may be subjected to step therapy or ”fail first policies”. These policies are tools that insurers use to evaluate the medical necessity or appropriateness of medications for specific diseases and conditions. Unfortunately, these policies require that individuals fail on at least one therapy before they are granted approval for the medication their health care provider prescribed. This process often results in significant delays in treatment, placing the individual at risk for loss of function, increased disease activity, and potentially irreversible progression or disability.
“When it comes to treatment, health care providers are best situated to determine which therapy is most appropriate for their patient’s needs,” said Amy Prentice, associate director, state government relations, NPF. "This law will help accelerate access to the therapies health care providers know will best manage a patient’s disease and provide them a better overall quality of life."
L.D. 1009 ensures that patient protections are in place for all state-regulated individual and state employee health care plans. Step therapy policies now must be based on appropriate studies, research and medical practices developed by experts with knowledge of the condition under consideration. The new law requires that a clear, accessible and convenient exceptions process must be made readily available. Also, insurers are required to reply within 24-hours for emergency exception requests, or two business days for non-emergency exception requests. If an exception request is not granted or denied within these timeframes, the exception will automatically be granted.
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.
Over the past five years, Maine legislators have passed similar versions of this bill only to be vetoed by former Governor LePage. This year, L.D. 1009 unanimously passed out of the Joint Committee On Health Coverage, Insurance, and Financial Services, and favorably passed through both the House and Senate. The new law will apply to health plans issued or renewed on or after January 1, 2020.
L.D. 1009 was sponsored by Representative Charlotte Warren (D), and co-sponsored by Senators: Robert Foley (R), Kimberly Rosen (R), Heather Sanborn (D), Linda Sanborn (D) and Eloise Vitelli (D), along with Representatives: Lori Gramlich (D), Teresa Pierce (D), Dwayne Prescott (R), and Denise Tepler (D).
Since 2014, the NPF has worked to have a new step therapy law enacted by leading a broad-based coalition of patient advocacy organizations. NPF met with various legislators to educate them on the impact of step therapy and hosted advocacy days in support of step therapy reform. NPF worked with patient advocates to write letters and meet with their lawmakers to ask for their support and testified in support of this legislation.
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.