Step therapy reform companion bills passed out of committees this week
On Tuesday of this week, the Senate Health, Human Services & Medicaid Committee passed Senate Bill (SB) 56 (version 21) and on Wednesday, the House Health Committee passed House Bill (HB) 72 (version 4), companion bills that would put into place patient protection guardrails for insurers who want to utilize the cost containment strategy known as "step therapy" and "fail first".
Senate Bill (SB) 56 will be the vehicle for moving step therapy reform legislation forward in the lame duck session. The House is expected to create a companion bill to the legislation in the Senate.
Three exemptions remain in the bill with some minor changes:
- The required drug is contraindicated for that specific patient, pursuant to the drug’s FDA’s prescribing information.
- The patient has tried the required prescription drug while under their current, or a previous, health benefit plan, or another FDA approved AB-rated prescription drug, and such prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event.
- The patient is stable on a prescription drug selected by their physician or other health care professional for the medical condition under consideration, regardless of whether or not the drug was prescribed when the patient was covered under the current or a previous health benefit plan.
The amended bill allows a health benefit plan to require a stable patient to try a pharmaceutical alternative, per the FDA’s orange book, purple book, or their successors, prior to providing coverage for the branded drug.
At the request of the Ohio Department of Insurance, the “best interest of the patient” exemption has been removed from the latest version of the bill. That exemption stated the required prescription drug is not in the best interest of the patient, consistent with medical or scientific evidence, and the physician or other health care professional documents the specific reason for the step therapy exemption in the patient’s medical record.
The OPPA has been an active member of the Step Therapy Coalition in Ohio and took a position of "Active Support" of the legislation when it was first introduced. OPPA member, Megan Testa, MD and Executive Director, Janet Shaw have been strong proponents of the bill, participating in "Day at the Legislature" events, providing testimony as well as meeting with legislators one-on-one.
We will continue to actively support SB 56 as it (hopefully) passes both chambers and becomes law in 2019!