Oklahoma Expands Patient Protections with Step Therapy Reform Law
National Psoriasis Foundation Works with 30 Advocacy Organizations to Pass New Legislation
Portland, Ore. (April 17, 2019)—The National Psoriasis Foundation, NPF, in coalition with 30 other patient and provider advocacy organizations thanks Oklahoma Governor Kevin Stitt, (R) and state lawmakers for passing S.B. 509 into law.
The new law requires any health insurance plan that utilizes a step therapy protocol to use clinical practice guidelines based on peer-reviewed and widely accepted medical practices when implementing the protocol. Guidelines ensure that step therapy protocols are based on the most accurate, up-to-date, evidence-based standards for disease treatment, like the Psoriatic Arthritis Treatment Guidelines issued by NPF and the American College of Rheumatology, and the Psoriasis Treatment Guidelines issued by NPF and the American Academy of Dermatology.
The law provides that step therapy exceptions shall be granted in cases when the prescribed drug will likely cause an adverse reaction or harm, the prescription drug will likely be ineffective, the patient has already tried the prescription drug and discontinued use, the prescription drug is not in the best interest of the patient, or the patient is stable on another prescription drug.
Additionally, insurance providers must respond to requests for exceptions or appeals within 72 hours, unless urgent circumstances exist, in which case insurers must respond within 24 hours. Patients may appeal any exception decision. The measure directs the Oklahoma Insurance Department and Oklahoma Health Care Authority to disseminate this law.
Currently, the estimated 96,318 Oklahomans living with psoriasis or psoriatic arthritis may be subjected to step therapy or fail-first policies, which insurers use to evaluate the medical necessity or appropriateness of the medication for the condition. Many times, these policies require that individuals fail on at least one therapy before they are granted approval for the medication their health care provider initially prescribed. This can result in significant delays in treatment, placing the individual at risk for loss of function, increased disease activity, and progression, and potential irreversible joint damage.
“We are thankful to the Oklahoma lawmakers that passed this very impactful law,” said Angie Thies, state government relations manager, NPF. “The new law is robust and positions Oklahoma as a leader in health care protections, joining only four other states to provide step therapy patient protections in the public market, and twenty states that include protections for individuals in the private market. We are extremely proud of the outcome of this coalition's efforts.”
Led by Senator Rader (R) of Tulsa and Representative Cyndi Munson (D) of Oklahoma City and with support from both the House and Senate, the passage of S.B. 509 will directly impact a patient’s ability to get the treatment that is right for them and ultimately improve their overall quality of life. The new law will go into effect on November 1, 2019.
“Thank you, Governor Stitt and members of the Oklahoma state legislature, for passing a law that protects patients from being given treatments that are not right for them. This new law will help all Oklahomans with chronic diseases have an easier time securing the appropriate medication needed to manage their disease,” said Nick Mietus, physician assistant, and NPF advocate. “This law reassures me that the decisions made between myself and my patients will be honored and not be adjusted by a patients insurance provider.”
Working in coalition with thirty organizations, NPF provided written testimony and executed a patient lobby day between patient advocates and key legislators to educate lawmakers on what it is like to be subjected to step therapy and negotiate the issue. The adoption of this law is an important milestone for patients in the state, as well as for NPF efforts to ensure patients have timely access to the most appropriate treatments.
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.