Governor Bill Lee Signs Step Therapy Reform Bill To Give Patients Better Access To Medications

Thursday, May 12, 2022

Patient advocacy groups, patients and healthcare providers are praising Tennessee lawmakers and Governor Bill Lee for a bill to reform an insurance practice known as “step therapy.” The law will help patients access the prescription medications prescribed by their doctors without interference from the patient’s insurance company. The bill passed the House 92 – 0, with one present not voting, and the Senate 33 – 0. Gov. Lee signed it into law on May 11.

 

“Step therapy” or “fail first” requires patients to try and fail on one or more treatments other than the medication their provider ordered before covering the originally prescribed treatment.

Delays in getting the proper care can lead to adverse health outcomes and worsening of conditions in some patients.

 

The legislation introduced by Rep. Mark Hall and Senator Joey Hensley puts common-sense parameters around step therapy but doesn’t eliminate the practice that can sometimes have beneficial outcomes. Instead, it establishes clinical review criteria requirements regarding an insurer's step therapy protocols for prescription drug coverage.

 

“This law will help thousands of patients and Tennesseans get access to care when needed after they have already been through the step therapy process,” said Steven Schultz, director of State Legislative Affairs at the Arthritis Foundation. “In the past, many patients have had to go through step therapy protocols, which forced them to try and fail medications their healthcare provider knew wouldn’t work for them. This will change that.”

 

Advocate for the legislation, Kristin Hatcher, who has Alpha-1 Antitrypsin Deficiency and testified at hearings for the bill, praised its passage, along with Annissa Reed, State Policy Manager for the National Organization for Rare Disorders (NORD). “Over 90% of rare diseases have no FDA-approved treatment, so their options are often extremely limited. We’re thrilled that this legislation will help rare disease patients in Tennessee be better protected and have easier access to the medications prescribed by their health care provider,” she said.


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