(BOSTON – 11/02/2022) Yesterday, Governor Charlie Baker signed legislation to limit the use of step therapy, or ‘fail first’ protocols that too often direct patients to cheaper medications rather than those more suitable to treat their condition. The bill, An Act relative to step therapy and patient safety, gives health care providers more leverage in determining the most effective treatment options for patients, saving patients expensive and painful regimens on medications they know to be ineffective or harmful. This law builds on similar legislation passed by the Senate in 2020, which was introduced by Senator Cindy F. Friedman (D-Arlington).
“This lawis a major step forward in ensuring patients and doctors have access to the right medication at the right time,” said Senator Friedman, Senate Chair of the Joint Committee on Health Care Financing. “We are finally joining over half the states in the nation in reforming step therapy practices, putting the focus back on health care providers working with patients to offer the best treatment possible.”
Step therapy serves as a cost-saving mechanism that can limit a patient’s ability to access the medication that is most suitable for treating their condition. Insurers that utilize step therapy protocols require medical providers to prescribe lower-cost medications to patients first, and only grant approval for alternative medications when the cheaper options have failed to improve a patient’s condition. In practice, this results in insurers effectively choosing medications for the patient, even in cases where their providers have recommended an alternative. When patients change insurers, they are often forced to start at the beginning of the step therapy protocol again, which results in wasteful health care expenditures, lost time for patients, and potentially devastating health care impacts on the patient.… Read more.