Act 181 Improves Current Step Therapy Requirements for Patients and Providers
Portland, Ore. (June 13, 2020)—The National Psoriasis Foundation, NPF, in coalition with 36 patient and provider advocacy organizations praise Governor John Bel Edwards and Louisiana lawmakers for the passage of Act 181 (H.B. 263). This new law enhances the existing step therapy law by providing the more than 115,000 Louisiana residents living with psoriasis and psoriatic arthritis access to the medications that their health care provider prescribes in a timely manner.
Louisiana was the first state to recognize the need for patient protections through step therapy reform with the passage of La. Acts No. 884 in 2010. Over the past decade, step therapy has become an increasingly common practice utilized by insurers to require a patient to “step through” or “fail” a series of medications before the insurer will cover the medication initially prescribed by the patient’s health care provider.
Since 2010, Louisiana patients and health care providers found a need for clarification and updates to the current law. Act 181 requires insurers to provide a clear process for submitting an exception request to the step therapy protocol if: treatments are contraindicated or will likely cause an adverse reaction or harm to the patient, treatments are expected to be ineffective, the patient has already tried the treatment and it was discontinued due to lack of efficacy, the treatment is not in the best interest of the patient, or the patient is receiving a positive therapeutic outcome on their current treatment.
Additionally, the legislation requires health plans make readily available a clear, accessible and convenient exceptions process. Insurers are required to reply within 24-hours for emergency exception requests, or 72-hours for non-emergency exception requests. If an exception request is not granted or denied within these timeframes, the exception will automatically be granted.
“It is exciting to see that once again Louisiana is putting patients first by improving protections and removing unnecessary health care barriers, which is crucial during a national pandemic,” said Kristen Stiffler, state government relations manager, NPF. “Strengthening existing step therapy legislation is the only way to ensure patients receive the appropriate treatments needed to manage their disease in an expeditious manner.”
Sponsored by Representative Mike Huval, H.B. 263 unanimously passed through both the House and Senate, and applies to state regulated insurance plans delivered, issued for delivery, or renewed on or after January 1, 2021.
Being the first state NPF has succeeded in strengthening existing step therapy laws, Louisiana is one of the 27 state to pass some form of step therapy legislation and joins more than two dozen states that include a clear process for submitting an exception request to step therapy protocols.
NPF worked in coalition with 36 patient advocacy organizations and was part of the steering committee negotiating amendment language with insurers and pharmacy benefit managers. Providing written testimony, NPF supported debate correspondence and patient advocacy testimonies for hearings and debates in support of this legislation.
NPF continues to work on behalf of all people living with psoriasis or psoriatic arthritis that cannot afford to delay access to the effective treatments prescribed by their health care provider. Placing patient protections around step therapy protocols will assist NPF to improve health outcomes for the more than 8 million individuals in the United States living with psoriasis and psoriatic arthritis. To learn more about how NPF works to reform step therapy visit www.steptherapy.com
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