AMCNO Continues to Support Step Therapy Reform; Promotes New Website

The AMCNO advocacy staff and representatives from more than 45 patient and provider groups across Ohio are working to raise awareness of the insurance industry practice known as “fail first” or “step therapy.” Step therapy protocols can be harmful to patients both financially and physically, causing an undue wait for the proper treatment, and, in some cases, a worsening of a person’s medical condition. Under step therapy, a patient must try one or more drugs chosen by his or her insurer—usually based on financial, not medical, considerations—before coverage is granted for the drug prescribed by the patient’s healthcare provider.

The AMCNO supported a bill in 2016 that would implement major step therapy reform by establishing new requirements for step therapy protocols required by health insurers and the Medicaid program. Recently re-introduced from last session, this legislation will give physicians a transparent and standardized process to appeal step therapy requirements for patients needing a particular treatment. The bill does not ban step therapy, or the number of steps an insurer can implement, and patients may still need a prior authorization from their insurers.

The Ohio Physicians for Step Therapy Reform website was just launched and includes information which physicians can use to learn more about the proposed legislation (SB 56 and HB 72), share their patients’ step therapy stories, and send messages of support to their state Senator and Representative through the “Take Action” option on the site.

Click here to access the website.  

The Pollen Line is now closed. See you in the spring!

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