Oregon Strengthens Utilization Management Protections for Step Therapy and Prior Authorization

Portland, Ore. (June 3, 2021) – The National Psoriasis Foundation (NPF) celebrates Governor Kate Brown’s signature of HB 2517 to create commonsense guardrails for step therapy and prior authorization in Oregon.

With the passage of HB 2517, Oregonians on a state regulated plan or state employee plan will have a clearer process to access the medications they need. Specifically, the new law creates transparency for prior authorization and step therapy by requiring insurers to post coverage requirements and step therapy protocols on their websites in plain language. These requirements are an extension of existing transparency measures from 2014.

Prior authorization and step therapy are utilization management tools used by insurance companies to evaluate the medical necessity or appropriateness of medications for specific diseases and conditions. Step therapy can require individuals to “fail first” on treatments selected by the insurance company before granting approval for the treatment prescribed by their health care provider. Prior authorization requests can be required every few months, even for a treatment an individual has been taking for years. These policies can result in delays in treatment, putting patients at risk of disease progression and otherwise unnecessary medical procedures or trips to the emergency department.

The passage of utilization management reform in Oregon is particularly special to NPF which has been headquartered in Portland, OR, since 1967. Since 2017, NPF has worked with other patient and provider organizations to strengthen utilization management guardrails. Today, 29 states have these protections in place. NPF volunteer patient advocates, board members, and team members have all spent time in Salem – both in person and more recently virtually – sharing how step therapy has impacted their access to timely and appropriate care.

“With the Foundation headquartered in Portland, we are thrilled to see such strong patient protections becoming law in our home state,” said Randy Beranek, President and CEO of NPF. “We have heard countless stories about step therapy causing delays for patients with psoriatic disease in Oregon, so we know that this new law will really make a difference for many people with chronic diseases.”

Beginning on January 1, 2022, patients and their providers will be able to request an exception to a step therapy protocol if: the treatment is contraindicated, the treatment is expected to be ineffective, the patient has already tried and failed the treatment, the treatment is not in the best interest of the patient, or the patient is stable on another medication covered by the plan. The request must also be granted or denied within 1 business day in exigent circumstances and 72 hours or 2 business days, whichever is later, in all other cases. Furthermore, prior authorization for maintenance medications will be valid for 1 year, reducing paperwork and potential delays in treatment.

“I want to extend a special thanks to my representative, Rep. Rachel Prusak, and Senator Bill Hansell for their leadership and dedication to getting these patient protections across the finish line,” said Pete Miller, NPF Board Member and Oregon resident. “My family has been personally impacted by step therapy, and I am so grateful to Oregon lawmakers for making sure there is a fair and transparent way for patients to get the treatment they need.”

NPF continues to work on behalf of all people living with psoriasis and psoriatic arthritis who cannot afford to delay access to the effective treatments prescribed by their health care providers. Placing patient protections around step therapy protocols will assist NPF to improve health outcomes for the more than 8 million individuals living with psoriatic disease in the U.S. To learn more about how NPF works to reform step therapy visit 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 psoriasis.org

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