Nov 2, 2022 - COVID

Gov. Charlie Baker signs "step therapy" bill

Illustration of a prescription bottle surrounded by plus signs and circles

Illustration: Sarah Grillo/Axios

Patients in Massachusetts will have better access to a wider array of medications after Gov. Charlie Baker signed a bill yesterday that was unanimously approved by lawmakers.

The big picture: The so-called "step therapy" bill will curtail the policy of insurance providers insisting on lower-cost treatments before approving coverage of more expensive medications.

  • Step therapy is when patients are required to try using cheaper drugs in their recovery before "stepping up" to pricier meds.
  • The new law requires insurance providers to approve or deny step therapy exemption requests within three business days, or 24 hours in an emergency, meaning faster access to the more expensive drugs.

Why it matters: A law allowing speedier exemptions to the step therapy process is a win for patients who would otherwise have to go through a lengthy authorization or review process.

  • Patients will be eligible for an exemption from the step therapy process if the cheaper drugs would harm them, if they have already tried and failed to improve on the drugs, if the treatment would be ineffective or if they're already stable using their preferred medication.

The other side: The law might make it harder for private insurers and public payers like MassHealth to control the growing cost of pharmaceuticals.

  • "Step therapy encourages prescribers to use prescription drugs that are safe, clinically appropriate, and cost effective before using drugs that could pose safety concerns or clinical concerns or have higher costs and is used in limited circumstances," Massachusetts Association of Health Plans President Lora Pellegrini told GBH News last year when the legislature was debating the issue.

Details: Advocates opposed to step therapy had been working for years to convince Beacon Hill leaders to limit or ban the practice.

  • Both the House and Senate passed bills to enhance the exemption and appeals process earlier this year.

The proposal nearly stalled out earlier this year when the two Democratic-controlled chambers couldn't agree whether the approval or denial of an exemption should take 72 hours or three business days, and 24 hours or one business day for emergencies.

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