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2017-08-21 Texas Step Therapy

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Step-Therapy Legislation Nears Effective Enrollment Date in Texas

Posted: August 21, 2017


Patients and physicians in Texas won a major victory against the step-therapy protocols instituted by insurance companies this spring with the passage of Senate Bill 680. The bill, sponsored by Senator Hancock, is nearing its effective enrollment date on September 1st of this year.

On September 1st, physicians will be allowed to continue prescribing a patient’s recommended course of treatment over the objections of health insurance providers. These objections are solely based around the cost of prescribed medication vis-à-vis their analogous or generic competitors, but do not take into account the best interests of the patient. The care provided by physicians is personalized to the individual, but step-therapy protocols assume that there is no impact to a one size fits all policy. In reality, patients that suffer from chronic conditions are subjected to unwarranted suffering.

An often overlooked aspect of step-therapy that Texas’s legislation helps alleviate is the administrative burden of negotiating treatments with insurance companies. Some physicians and patients were forced to wait as many as 53 days for insurance companies to adjudicate their cases, time in which patients went without their best course of treatment. During this period of time physicians and their staff are also forced to spend their time negotiating an insurance company’s bureaucracy, creating significant administrative overhead for providers and insurers alike. The CSRO has estimated these costs to total between 20 and 30 billion dollars annually, further inflating the costs for patients.

To learn more about CSRO’s step-therapy advocacy efforts or how to get involved, visit the step therapy section on this website.

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