Association of Diabetes Care & Education Specialists

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Movement in States to Roll Back Step Therapy Legislation

Feb 09, 2017

A number of national organizations, including the National Psoriasis Foundation, the American Academy of Pain Management and the International Myeloma Foundation are part of a growing coalition of organizations working in specific states to pass legislation that will restrict the use of step or “fail first” therapy.

The AADE Advocacy department is joining this growing coalition and will contact State Coordinating Bodies (CBs) to help pass the legislation.

What is Step or “Fail First” Therapy?

Heath insurers use step therapy, also known as “fail first,” to control spending on prescription drugs. Under this protocol, patients must “fail first,” often multiple times, on certain medications before they are able to receive the treatment originally prescribed by their provider. As a result of these delays in access to optimal therapy, a patient’s condition can be exacerbated.

In addition, step therapy can interfere with a prescriber/patient relationship.

Often when a patient’s insurance changes, the new company requires the “fail first” process to start again. With no limitations, “fail first” wreaks havoc on the lives of patients with chronic disease, as well as their providers.

What the Legislation Does

While not identical in every state, the legislation sets forth the conditions under which the insured, with the assistance of the prescriber, can bypass step therapy and receive medication as initially prescribed.

Where Legislation is Headed

So far this legislation has passed in New York, West Virginia, Indiana, Illinois, Missouri, Kansas, and California.

A bill was just introduced in Oregon, and there are additional plans to introduce this bill in other states soon. Read the Oregon Step Therapy Bill.

What You Can Do

The AADE Advocacy department will keep you updated on this legislation. If this legislation is introduced in your state, we will need your help to:

  • Call or email to your state legislator to ask for their support.
  • Possibly testify on the bill and tell stories from your patients’ perspectives.
  • Talk to your legislators in their district offices about the legislation.

State Grassroots Coordinator

AADE encourages all State CBs to appoint a State Grassroots Coordinator (SGC). A SGC acts as a single point of contact for the state on important advocacy issues. This will help your CB to get information rapidly and to get active quickly. Visit MY AADE NETWORK and contact your state’s CB leadership team to see how you can get involved.

If you have any questions or comments, please contact Director of Advocacy, Kurt Anderson.

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