Posted: June 29, 2018
Late in Maine’s 2018 session, the legislature passed two separate patient protections measures of benefit to patients battling chronic illnesses. Passing two separate pieces of legislation reforming utilization management techniques in the same session is a tremendous feat, although more work remains to be done. Irrespective of the Governor’s decision on these two pieces of legislation, there is substantial momentum to protect patients from overzealous use of utilization management techniques by pharmacy benefit managers and health plans.
The first of these bills, LD 1407, reforms the use of step-therapy protocols in the state. The legislation requires that step-therapy protocols be based on clinical practice guidelines, and provides physicians a number of exceptions that allow them to override any step-edits in cases of medical necessity.
The second piece of legislation sought to protect patients from non-medical switches. When it was introduced, LD 696 protected patients from non-medical switches on a year over year basis. The version that was eventually passed by the legislature was substantially watered down, but a step in the right direction nonetheless. In its current form, the legislation requires 60 day advance notification of adverse formulary changes, and instructions for physicians on available exceptions processes. Advocates hope to strengthen these protections in the coming year.
Both of these bills await action by the Governor. We urge the Governor to sign both of these important pieces of legislation.