On November 1, 2022, the Governor signed H.4929 known as An Act relative to step therapy and patient safety. It was a bill filed by Rep. Roy and Rep. Marjorie Decker that ensures that all constituents in the Commonwealth can receive medicine that their doctors prescribe. It aids these populations by removing needless insurance protocols that delay necessary treatment and access to medication. It removes the barriers that interfere with sound medical judgments made within the confines of the physician-patient relationship.
Below are Rep. Roy’s remarks from the House floor:
Rep. Roy and Rep. Decker filed the bill after hearing countless stories of patients being forced to take drugs that their health insurers want as opposed to what their doctors think is best. It’s an insurance practice called Step Therapy, whereby patients are required to try, and fail on, insurer-preferred drugs before getting access to the drug their doctor knew would have the best chance of working. Patients and advocates call it “Fail First” for obvious reasons.
Sometimes patients are made to go through step therapy multiple times and, defying logic, some are made to try, and fail on, drugs they’ve already failed on previously, causing them intense stress and disease progression. It results in more trips to the doctor’s office, the emergency room, and hospitalizations, all which lead to increased healthcare costs.
And from doctors, they heard stories of frustration as they watch helplessly while their patient’s conditions worsen, despite appeal after appeal.
For patients with chronic diseases, adding to their stress by delaying access to the medicine they need is unacceptable. We live in a state that has some of the best healthcare in the world. We can and should do better to protect our sick patients.
H.4929 ensures that all patients in the Commonwealth can receive medicine that their doctors prescribe. The bill doesn’t ban step therapy, but it does require an expedited appeals process to maintain continuity of care. It also allows the medical professional to override step therapy when medically necessary. Finally, patients would be granted an exception if they’ve already tried, and failed on, the medication the insurer is requiring them to try.
We remain respectful of the insurers who, we know, are businesses. But we are steadfast in our belief that patients have a right to have access to the medicines their doctors say they need.
jeffreyroy.com 