Posted: May 29, 2020
Step therapy protocols, also known as "fail first," require patients to try and fail certain drugs before coverage is provided for the drug originally prescribed to the patient. Unfortunately, step-therapy protocols have become an impediment to care for patients, and an extreme administrative barrier for physicians. The one-size-fits-all approach has hampered treatment decisions arrived at through the course of the patient-provider relationship.
As CSRO President, Dr. Madelaine Feldman, wrote earlier this Spring: “For Louisianans with chronic health conditions, it is important to get timely access to the medications and treatments they need. We must ensure that doctors and their patients, not a one-size-fits-all insurance policy, make the right decision for the right treatment at the right time.”
Louisiana was among the first states in the country to recognize the issues that had developed with step-therapy by passing a law to reform the practice at the beginning of the decade. However, it has become apparent over time that the law required updates to function effectively. In response CSRO, the Rheumatology Alliance of Louisiana, and a coalition of like-minded stakeholders spearheaded introduction of legislation.
In Louisiana this session, SB 59 by Senator Fred Mills and HB 263 by Representative Mike Huval seek to update Louisiana’s existing step-therapy statute to meet today’s challenges. Specifically, the bills do so by creating minimum standards for setting up a step-therapy protocol, additional scenarios under which an exception must be granted, and timelines within which a health plan must respond to an exception request.
While the legislature was forced to suspend session for a month due to the pandemic, they came back in early May to deal with business that had to be completed by June 1st. CSRO is pleased that on the evening of Thursday, May 28th, the Louisiana State Senate passed HB 263 with a 35-0 vote. This progress came on the heels of unanimous passage through the House. CSRO thanks Senator Mills and Representative Huval for their leadership on this issue, and tireless advocacy in an environment with severe operational constraints.
HB 263 is now headed to the House for concurrence before making its way to the Governor’s desk.