Senate Republican Office
FOR IMMEDIATE RELEASE
Senator Kimberley Rosen Submits Bill to Limit Step Therapy Protocol
Legislation would protect patients with life-threatening diseases, including mental illness, by ensuring insurance companies can’t deny patients access to the drugs they need
AUGUSTA – State Senator Kimberley Rosen (R-Hancock) has introduced legislation to ensure that those suffering from chronic, life-threatening diseases, including mental illness, aren’t denied access to the prescription medications that they need.
Step therapy, also referred to as fail first, is a protocol commonly used by insurance companies to curb costs by denying patients the prescription their doctor has ordered in favor of a medication that is preferred by the insurance company. That preference is typically based on the best financial interest of the insurer, not the best medical interest of the patient. If the patient tries the preferred substitution and fails or suffers an adverse reaction, the insurer will then require the patient to try another medication—of their choosing. Patients can be forced to fail multiple times on medications other than what their doctor has prescribed before gaining access to the drug originally recommended by their physician.
Senator Rosen’s bill, LR 1195, “An Act Regarding Prescription Drug Therapy,” would put guardrails around the use of step therapy in a few specific instances where a drug failure could cost the patient their life or put them at great risk in certain instances.
“While it’s important for health insurance companies to identify savings to keep the cost of health insurance down, I think we can all agree that the overall health and wellbeing of the patient should be first and foremost,” said Sen. Rosen. “If you have a form of advanced cancer and don’t have long to live, but there’s a drug that your doctor thinks could ease your pain or save your life, then you don’t have time to fail on two or more drugs before you gain access to the medications you need.
“Likewise, if you suffer from a mental illness such as schizophrenia and your physician has found a medication that works for you, it would be dangerous and irresponsible to take you off of the medication to experiment with other prescription drugs before you receive coverage for the prescription you need to lead a normal and productive life; and it wouldn’t make financial sense either. The cost of inpatient and outpatient services that would likely be required due to the transition onto new prescription medications would greatly outweigh any pharmaceutical cost savings.”