North Carolina Improves Patient Access Through New Step Therapy Reform Law
Portland, Ore. (July 8, 2020)—The National Psoriasis Foundation, NPF, along with Fair Health North Carolina, a coalition of leading North Carolina patient and provider advocacy organizations, thank Governor Roy Cooper for signing S.B. 361. This new law enables individuals living with chronic diseases like psoriasis and psoriatic arthritis and their health care providers to access a clear exceptions process that will allow them to bypass step therapy requirements when they are not medically appropriate.
With the passing of this law, North Carolina residents will no longer be forced to try and fail ineffective treatments before accessing the treatment initially prescribed by their health care provider. For patients living with serious or chronic illnesses like psoriasis or psoriatic arthritis, prolonging ineffective treatment and delaying access to the right treatment could result in increased disease activity, loss of function and possible irreversible joint damage.
This new law 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.
Now, North Carolina residents will no longer be forced to follow a one-size-fits-all step therapy protocol that doesn’t take into consideration a patients’ unique treatment history and ensures that patients receive the treatments their health care provider knows will be most effective in managing their disease.
The passage of this bill has been five years in the making, with NPF as an original leader in this multi-year effort. Fervent and dedicated NPF advocates, particularly PJ Leary and Brian Lehrschall have been involved since the beginning in working with NPF to lay the groundwork for this bill, provide patient testimony, and organize and participate in advocacy days while working in partnership with other members of the coalition. Unfortunately, PJ Leary passed away in 2016 before meaningful step therapy reform was passed in North Carolina.
“The passing of this bill is validation that five years of hard work has paid off,” said Brian Lehrschall, co-chair of the NPF Eastern Advocacy Action Network . “Over the years others and I have needlessly suffered by having to try medications that our doctors knew would not effectively manage our disease just to prove to insurance providers that what was initially prescribed is the most effective treatment. This wasted time and money, and for many led to the progression of their disease. 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."
North Carolina is the third state to pass step therapy legislation in 2020 and joins 27 other states to require a clear process for submitting an exception request to step therapy protocols. Sponsored by Representative Larry Potts and Senator Joyce Krawiec, S.B. 361 applies to insurance contracts issued for delivery, renewed or amended on or after October 1, 2020.
NPF continues to work on behalf of all people 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 individuals in the United States 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, education, and funding, 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 individuals in the United States 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 $24 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.