Governor Nixon Signs Step Therapy Reform Bill

Step therapy reform legislation sponsored by state Rep. Denny Hoskins was signed into law this week by Governor Jay Nixon.

“As lawmakers, it’s our responsibility to do what’s right to help ensure Missouri residents have the best access to the most effective treatments,” said Hoskins, R-Warrensburg. “Only patients and their doctors know what medicines will work best for them—not insurance companies. I’m glad that Governor Nixon heard the many voices of patients who spoke out about their issues in accessing their needed medications.”

HB 2029 will ensure patients have access to the medication that their doctor prescribes, and limits insurance company interference in the prescribing practice of physicians.

Step therapy is a cost savings tool utilized by the insurance industry that forces patients to take and fail on medications other than what their health care provider has prescribed, before their insurer will cover the cost of the original medication.

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.  Step therapy does not take into account an individual’s medical history or other factors, but instead relies upon a pre-determined prescription drug formulary or protocol.

The new law doesn’t ban step therapy, nor the number of steps insurers can implement, and it doesn’t prohibit insurers from having patients try a generic version of a medication. HB 2029 does however say that once a patient has gone through step therapy and is stable on a medication that the patient will not have to go through step therapy again just because they change doctors, insurance or if the medication is reclassified. Furthermore, the legislation does provide a standard and transparent process for health care providers to appeal step therapy requirements for patients based on their individual medical needs.

HB 2029 was supported by more than a dozen patient advocacy organizations who shared stories of the negative impact step therapy has had on their medical conditions.

Step therapy reform legislation has been passed in additional states this year, including Illinois, Indiana and West Virginia.  Other states including New York, Ohio and North Carolina have similar legislation pending.