2020-04-21 SD Enacts Step Therapy Reform

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South Dakota Becomes Latest State to Enact Step Therapy Reform

Posted: April 21, 2020

On Tuesday, March 24^th South Dakota Governor, Kristi Noem, signed SB 155 into law as S.J. 588. The law provides sorely needed reforms to the step-therapy process for patients and providers in South Dakota. Final approval of the measure capped an effort by a broad coalition of stakeholders, including CSRO and rheumatologists from the Rheumatology Association of Minnesota and the Dakotas (RA-MD).

CSRO thanks the South Dakota rheumatologists and RA-MD members who took the time to advocate for passage of the measure. Their letters and testimony helped guide the bill’s passage and provided valuable insight to lawmakers in Pierre.

The new law creates transparency and defined criteria under which certain health plans must permit a prescriber to override a step therapy protocol. An override of a step-therapy protocol must be granted if any of the following circumstances apply:

• The required drug is contraindicated;
• Due to a documented adverse event or a documented medical condition the required drug is likely to:
  • Cause and adverse reaction;
  • Decrease ability to achieve or maintain reasonable functional ability in performing daily activities;
  • Cause physical or mental harm;
• The required drug is expected to be ineffective;
• The covered person has tried and discontinued a therapeutically equivalent dose of the required drug due to lack of effectiveness;
• The covered person is currently receiving a positive therapeutic outcome on a prescription drug for the medical condition under consideration.

Importantly, the bill also creates clear timelines for when a health plan must issue a determination on a step therapy exception request. A determination must be issued within five calendar days for non-urgent requests, or within 72 hours if exigent circumstances exist.

Certain plans under state regulatory jurisdiction issued on or after January 1, 2021 will be subject to the new law.

Read Full Text of SB 155

CSRO’s work, however, is not finished. Proper implementation and compliance with the law will be as important as the passage of the law itself. CSRO will continue working with stakeholders to ensure that complaints are properly documented and appropriate enforcement action is taken. To that end, please contact info@csro.info with concerns or issues you may experience.