The Connecticut General Assembly has just six weeks left in its 2014 legislative session, with limited time set aside for votes on a number of important bills. As our state’s leaders work to complete their business for the year, The Leukemia & Lymphoma Society (LLS) and its Connecticut Chapter hope that one bill in particular won’t be forgotten: S.B. 394, designed to improve the safety of an insurance practice called step therapy.
Step therapy is a technique that insurers commonly use to help control drug costs. Under step therapy, an insurer places a coverage restriction on certain prescription medications. Before the plan will authorize coverage for a medication on that list, a patient is required to first try other, generally less expensive, drugs to see if they will be effective. In Connecticut, step therapy is applied to drugs used to treat a wide range of diseases and conditions, including cancer, diabetes, HIV/AIDS, mental health, multiple sclerosis and other rare diseases.
In some instances, step therapy can be an effective tool. But if its duration and effectiveness are not carefully managed, step therapy can also lead to significant negative consequences for a patient. A number of factors contribute to this. First, the drug sequences required under step therapy are not based on the medical profile of a specific patient or on assessments provided by a patient’s treating physician. Rather, these sequences are based on cost and on general expectations about potential treatment responses. Also, insurers may require patients to try the same drug repeatedly and over any length of time, as the law does not place any constraints on the duration of a step therapy protocol. That means patients may be obligated – for an indefinite period of time – to delay taking the medication that was initially prescribed by their health care providers.
For many cancer patients, every day is a battle. From the moment of diagnosis, patients rightfully want to know that they will have access to the treatment plan determined by their medical team to offer the greatest clinical benefit. When step therapy stands in the way of treatments that are medically necessary, LLS believes that patients and their health care providers should have access to a clear and speedy process for seeking an exemption from an insurer’s step therapy protocol. This simple protection is the crux of S.B. 394.
Last year, the General Assembly took steps to address this issue by enacting a law that was nearly identical to S.B. 394 but which applied only to Medicaid patients in Connecticut. Now, we have the opportunity to offer patients in the commercial insurance market this same important protection, and several lawmakers, including state Rep. Linda Orange, D-Colchester, are behind this effort. LLS applauds her initiative and calls on the General Assembly to finish the good work it started last session, by passing S.B. 394.
Like the step therapy protections enacted last year, this bill offers a common-sense, balanced solution: Insurers will be able to continue using step therapy to achieve important cost-savings, while patients and medical providers will be better empowered to drive treatment decisions.
Marialanna Lee is director of State Government Affairs, Northeast Region, of The Leukemia & Lymphoma Society, Office of Public Policy.