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July 21, 2015

Advocates Mobilize Against Step Therapy in NC

2015-07-21 | July 14, 2015

(Raleigh, NC) Advocates here mobilized today against step therapy, a dangerous practice in which insurers require patients to “fail first” on a medication before they can access their preferred, prescribed treatment.

Doris Ann Price, NPAF President Council volunteer, took part in an advocacy day in support of proposed legislation, meeting with various legislators to share her personal cancer story.

“Had my insurer let me have the new treatment originally prescribed by my oncologist instead of making me wait two years and fail first on older drugs, my cancer might not have spread so quickly,” said Doris Ann in an op-ed in The News & Observer.

Advocates asked that any legislation increase oversight, ensure patient safety, establish minimum exceptions rules and ensure transparency in the exceptions process.  The proposed North Carolina legislation would:

  • Ensure that step therapy programs are based on clinical guidelines developed by independent experts.
  • Ensure that the exceptions process for step therapy is transparent and accessible to patients and health care providers.
  • Establish a basic framework for when it is medically appropriate to exempt patients from step therapy.

The proposed legislation does not prevent insurers from using step therapy or limit the number of allowed steps. It does not require insurers to develop a new exceptions process or stop them from requiring prior authorization before covering a drug.

During the advocacy day, Doris Ann met with NC Senators Josh Stein and Jeff Jackson, and Representatives Jon Hardister, Ken Goodman and Tommy Tucker.