Patients in Massachusetts will have better access to a wider array of medications after Rep. Jeffrey N. Roy’s step therapy bill was signed by Gov. Charlie Baker last week. Roy filed the bill in the House with Rep. Marjorie Decker (D-Cambridge). The bill will curtail the policy of insurance providers insisting on lower-cost treatments before approving coverage of more expensive medications.
“We’ve heard countless stories of patients being forced to take drugs that their health insurers want as opposed to what their doctors think is best,” said Rep. Roy. “This is a great, common-sense measure to help patients get the care that their physician believes they need. It removes needless insurance protocols that delay necessary treatment and access to medication and removes the barriers that interfere with sound medical judgments made within the confines of the physician-patient relationship.”
The new law requires insurance providers to approve or deny step therapy exemption requests within three business days, or 24 hours in an emergency, meaning faster access to the more expensive drugs. It is a win for patients who would otherwise have to go through a lengthy authorization or review process.
Roy further noted the old “Fail First” practice was untenable for obvious reasons. “Adding to patient stress by delaying access to the medicine they need is unacceptable,” he added. “We live in a state that has some of the best health care in the world and this legislation restores access to that great system for all patients. I thank the many volunteers and advocacy groups who shared stories and pushed for this bill.”
Patients will be eligible for an exemption from the step therapy process if the cheaper drugs would harm them, if they have already tried and failed to improve on the drugs, if the treatment would be ineffective or if they’re already stable using their preferred medication.
Advocates opposed to step therapy had been working for years to convince Beacon Hill leaders to limit or ban the practice.