S.B. 155 Provides Patient Protections for Step Therapy Protocols
Portland, Ore. (March 27, 2020)—The National Psoriasis Foundation, NPF, applauds Governor Kristi Noem and South Dakota lawmakers for the passage of S.B. 155. This new law will assist the more than 21,000 South Dakota residents living with psoriasis and psoriatic arthritis receive the medications that their health care providers prescribe in an expeditious manner.
Currently, patients may be subjected to step therapy or ”fail first policies”. These policies are tools that insurers use to evaluate the medical necessity or appropriateness of medications for specific diseases and conditions. Unfortunately, these policies require that individuals fail on at least one therapy before they are granted approval for the medication their health care provider initially prescribed. This process often results in significant delays in treatment, placing patients at risk for loss of function, increased disease activity and potentially irreversible progression or disability.
S.B. 155 requires state regulated insurance health plans make readily available a clear, accessible and convenient exceptions process. Insurers are required to reply within 72-hours for emergency exception requests, or five business days for non-emergency exception requests. If an exception request is not granted or denied within these timeframes, the exception will automatically be granted.
Patients will be granted exceptions 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 stable on their current treatment.
“We thank Governor Noem and all South Dakota lawmakers for understanding the importance of preserving the patient provider relationship,” said Kristen Stiffler, state government relations manager, NPF. "The passing of S.B. 155 will help accelerate access to the therapies health care providers know will best manage a patient’s disease and provide them a better overall quality of life."
Sponsored by Senator Kris Langer and Representative Michael Diedrich, S.B. 155 unanimously passed through both the House and Senate, and will apply to state regulated health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2021.
This is the first state step therapy legislation passed in 2020. South Dakota is the 27 state to pass some form of step therapy legislation and joins 21 other states that include these exceptions.
Actively engaging in on the ground advocacy efforts in South Dakota for the first time, NPF worked in coalition with more than 20 patient advocacy organizations to meet with and educate various legislators about the impact of step therapy. NPF also recruited various co-sponsors and worked with patient advocates, providers and insurers to provide testimony 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 Americans 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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