Senate committee hears bill limiting 'step therapy' by health insurers – Columbia Missourian
JEFFERSON CITY â Under “step therapy,” patients can be required to take the most cost-effective medicine, with health insurers letting the patient switch to a more costly medication when the first one did not work.
Sen. Doug Beck wants to change that.
Beck, D-St. Louis County, sponsors a bill that would provide more exceptions to the insurance protocol. He said his bill âdoes not ban step therapyâ but will improve it instead. He said the bill will add âspecific instances where the therapy will be changedâ and will âkeep the overall efficiencyâ of step therapy.
The Senate Insurance and Banking Committee held a public hearing on the bill, Senate Bill 959, Tuesday. It would establish exceptions overriding step therapy in four circumstances:
First, when the step therapy protocol is âreasonably expectedâ to be ineffective and a delay in treatment will lead to severe consequences.Second, when a condition exists in a patient that will likely make the step therapy treatment harmful.Third, when the step therapy treatment will prevent a patient from attaining a âreasonable and safe functional abilityâ in their daily and working lives.Fourth, when a patientâs condition is stable while using prescription drugs that have previously received approval for coverage.
Several people with chronic conditions spoke in support of Beckâs bill.Â
Susanne DâAngelo, whose 17-year-old daughter has the same incurable chronic condition as she does, said her health insurance provider wanted her to hold her daughter down and inject her with a drug that was ânot the right medicine.”
âI canât do that to my child, so Iâm asking you to pass this bill,â she said.
D’Angelo’s doctor, Julie Baak, also testified in favor of the bill. Baak runs a medical center in St. Louis that focuses on autoimmune, inflammatory and chronic illnesses. She said drugs for rheumatology and some other diseases are ânot even one size fits most.â Doctors like Baak would make decisions with their individual patients.
âHealers and patients stand together,” she said. “Who are the insurance administrators to insert themselves in that situation?â
Moreover, Baak said she âis so not OKâ with step therapy requiring a drug treatment to fail before a patient can use another one.
âWhen youâre asking a rheumatology patient to fail a therapy, youâre putting them into a flare, youâre causing permanent damage,â she said.
Opponents to this bill included representatives from health insurance companies. Shannon Cooper, a former state representative and current lobbyist on behalf of Blue Cross Blue Shield of Kansas City, said step therapy has âbeen around for yearsâ and âhelps manage the cost.â
For Cooper, passing this bill would make it harder for health insurance companies to control premium prices.
âWhat youâre gonna find out, youâre gonna have more and more uninsured people in the state,â he said.