2.21.17

A bill before the 2017 Oregon Legislature would help protect patients from problems stemming from insurance companies’ use of step therapy, a restriction that insurers use to avoid covering more expensive medications, even if they were prescribed by a doctor.

A hearing today will be held on Senate Bill 526, sponsored by Sens. Jeff Kruse and Lew Frederick, before the Senate Committee on Health Care.

Those in support include the Chronic Disease Coalition.

“Rather than address patients’ health care needs, step therapy denies coverage of proven and effective medical treatments, worsens a patient’s condition and increases the overall costs to the health care system,” CDC Executive Director Scott Bruun said in testimony submitted ahead of the hearing.

Here are five more takeaways from testimony in support of the bill:

1. Thea Zajac of The Leukemia & Lymphoma Society said step therapy can lead to delays in access to medication offering the greatest medical benefit for cancer patients.

    “According to a recent study, 67% of patients whose specialty drugs were rejected under step therapy did not receive an alternate drug within a 30-day window,” she said. “In these cases, patients may experience disease progression, a serious risk for patients dealing with life-threatening conditions such as cancer.”

2. Lisa Butler of GBS-CIDP Foundation International said patients with Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), and related conditions, such as Multifocal Motor Neuropathy (MMN), “do not have the luxury of ‘failing first’ on a more cost effective medication before moving onto a better treatment.”

    “These (diseases) are complex and nuanced, and only the patient and their healthcare provider know the best course of action,” she said. “Any delay in treatment could result in lingering disability or worse, jeopardizing the patients’ health and the family livelihood.”

3. Steven Schultz of the Arthritis Foundation said the bill would protect arthritis patients as well.

    “For patients with complex conditions, such as rheumatoid arthritis, it is critical to ensure they have timely access to medications that can put their disease into a low disease state or medicated remission,” he said. “And for those patients that meet one of the criteria listed in SB 526 it could mean stopping their condition from causing irreversible damage and joint destruction.”

4. A group of organizations testifying together included the American Diabetes Association, Hemophilia Oregon, National Psoriasis Foundation, individual doctors and the Oregon Rheumatology Alliance.

    Step therapy frequently “delays access to optimal therapy, while potentially exacerbating a patient’s condition,” they wrote. “The relationship that a patient, especially those with chronic illnesses, has with their doctor is vital.”

5. Seth Ginsberg, co-founder of the Global Healthy Living Foundation, added:

    “This is a sensible bill that ensures the wellness of Oregon’s most vulnerable citizens by protecting the individualized treatment decisions that are made between the provider and the patient.”

We hope Oregon lawmakers will support Oregonians with chronic conditions by passing this bill. You can read the Chronic Disease Coalition’s full testimony by clicking here.