Bill Passed To Undo ‘Step Therapy’ Rule

The California Legislature approved a bill (AB 374) last week to allow providers to sidestep the so-called “step therapy” rule, under which health insurers can require some patients to fail one therapy protocol before they’re allowed to move on to a more expensive one.

The cost-saving rule can be disastrous to some patients with severe illnesses such as lupus, epilepsy or multiple sclerosis, according to Assembly member Adrin Nazarian (D-Sherman Oaks), the bill’s author.

“What is most painful in that process is the time lag — sometimes as much as 90 days,” Nazarian said at a legislative hearing.

He said he understood the reasons behind gradual escalation of medications, but that a one-size-fits-all approach to limiting medication may not actually fit anyone. 

“Keeping health care costs down is important,” Nazarian said in a statement, “but we must not allow cost-cutting to become more important than a patient’s well-being.”

AB 374 allows providers in California to fill out a form to bypass step therapy requirements.

The bill passed floor votes in the Assembly and Senate last week and now needs the governor’s signature to become law.

Under the proposed law, once the health plans receive the form, they have 72 hours to respond. If the request is deemed urgent, the plans would have 24 hours to answer. Then, if the provider didn’t receive an answer during the allotted time, the request would be considered approved.

Nazarian said, in some instances, patients have to try five different medications and fail them all before they’re allowed to get the medication of their provider’s choice. That time delay increases risk and pain for those patients, he said.

The governor has until Oct. 11 to sign or veto bills passed this session.

Categories: Capitol Desk, Insurance