Bill Would Limit Practice of ‘Step Therapy’ for Coverage of Pain Drugs

Assembly member Jared Huffman (D-San Rafael) recently introduced a bill (AB 369) that would limit insurers' ability to require patients to try generic or low-cost pain medications before receiving coverage for the treatment recommended by their physician, the San Francisco Chronicle reports.

Bill Details

Under the proposed legislation, insurers could use the practice -- known as "step therapy" or "fail first" -- for two medication attempts. If both attempts are unsuccessful, health plans would need to cover the treatment prescribed by the patient's physician.

Last year, Huffman introduced a bill that would have banned step therapy altogether. The legislation passed the Assembly, but failed in the Senate Appropriations Committee. An analysis of last year's bill found that it would increase health care costs, particularly for public health insurance programs such as Medi-Cal, California’s Medicaid program.

Huffman said he hopes the newer, scaled-down version of the bill will be successful.

Health Plans Respond

Health insurers have said that step therapy helps control costs by encouraging physicians and patients to try less expensive medications first.

They also said the practice can curb drug misuse because it steers patients toward less-addictive pain medications (Colliver, San Francisco Chronicle, 2/26).