House Approves Bills Exempting Certain Patients from Step Therapy
Two bills related to step therapy passed the Oklahoma House of Representatives this week. House Bill 2748, authored by Rep. Nicole Miller, R-Edmond, prohibits step therapy requirements for certain prescription drugs to treat advanced metastatic cancer and associated conditions. Miller, who worked with the Susan G. Komen organization on the legislation, emphasized that people with stage-four cancer do not have the time to go through a "fail first" method rather than trying the drug originally prescribed by their doctor. It's estimated that 168,000 people in the United States are currently living with metastatic breast cancer. "I know how vital timely, effective treatment is, especially for patients with stage-four cancer, and 'fail first' policies waste precious time when patients don't have any time to spare," said Miller, a breast cancer survivor. "If a doctor prescribes this and says it’s the best medication for their patient, insurance companies should not be allowed to overrule their medical advice." HB2748 passed the House 96-0 Tuesday and is now eligible to be heard in the Senate, where it's authored by Sen. Brenda Stanley, R-Midwest City. On Wednesday, the House approved another bill related to step therapy: House Bill 1736 by Rep. Tammy Townley, R-Ardmore, HB1736 requires health benefit plans to implement a clear process for a participant or beneficiary with chronic respiratory failure consequent to chronic obstructive pulmonary disease (CRF-COPD) to request an exception to step therapy protocol in order to receive the requested treatment. The bill outlines several situations where an exemption may be requested: Other treatments required under protocol are ineffective; Delaying effective treatment would cause severe consequences; Other treatments are likely to cause harm; Other treatments will prevent a participant from maintaining necessary functional abilities; or The patient’s disease is life threatening. "Step therapy delays powerful, necessary treatments patients need by requiring them to take alternative medications before they can begin the plan their doctor prescribed," Townley said. "We want patients to get the right care immediately rather than be delayed by red tape." Under HB1736, the health benefit plan must publish requirements and information for requesting an exception to a treatment step therapy protocol to its website. The insurer must respond to exception requests within 72 hours, and all expedited determinations of exception within one business day. HB1736 passed the House 94-0 and may now be considered in the Senate, where it is also carried by Stanley.