BILL TARGETS "FAIL FIRST" APPROACH TO HEALTH CARE
By Katie Lannan
STATE HOUSE NEWS SERVICE
STATE HOUSE, BOSTON, SEPT. 10, 2019.....More than 20 states have passed legislation aimed at ensuring patients can have timely access to the specific treatments recommended by their doctors, advocates said Tuesday as they urged Massachusetts to become the next to do so.
Bills filed by Rep. Jennifer Benson and Sen. Julian Cyr (H 1853/S 1235) take aim at the practice known as step therapy or "fail first," in which insurers direct patients first to more cost-effective alternative medications before approving coverage for a treatment recommended by their doctors.
At a briefing, Mary Bartlett of the Arthritis Foundation said step therapy is often used because of cost, but that the practice can delay access to the treatment a doctor knows will work best for a particular patient.
During those delays, she said, the patient can endure pain, costly medical procedures to manage effects of their condition and the psychological toll of knowing there is a drug out there that they cannot access.
Anna Legassie, an arthritis patient who was diagnosed 25 years ago, said access issues around the biologic drugs she takes "have gotten harder and harder and harder."
She said an insurer at one point had asked her to try two drugs, for four months each, that had previously failed for her, and that reforms like the ones proposed on Beacon Hill could help protect patients from such situations.
Legassie said that even though she's stable on her current treatment, she's been faced with the prospect of step therapy again when she or her spouse have changed jobs and health plans.
"After a while you start to feel like you're being punished for being successful or being upwardly mobile in your career, and when you're presented with what could be your dream job, there's this whole other set of considerations of, is this worth it?" she said. "Is this job worth it if I have to start all over and go through step therapy again with no guarantees?"
Benson and Cyr's bills, which were referred to the Health Care Financing Committee last month and have not yet had a hearing, would impose what Amy Prentice of the National Psoriasis Foundation called "patient guardrails" around step therapy.
They would create a state commission on step therapy protocols and establish a series of exceptions from step therapy, in cases including where the required drug will likely cause an adverse reaction or is expected to be ineffective, where the patient has tried the required drug previously, or the patient is stable on a drug chosen by their health care provider.
Brendan Abel of the Massachusetts Medical Society described the bill as "thoughtfully crafted."
"It's not a blunt instrument," he said. "It is a thoughtful batch of safeguards that we think will be really important for patients and for physicians' ability to care for patients across Massachusetts. We think that this legislation will put patients and their best clinical interests first."
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