National Psoriasis Foundation Leads Coalition of 26 Advocacy Organizations to Pass New Law
Portland, Ore. (April 29, 2019)—The National Psoriasis Foundation, NPF, along with twenty-six other patient and provider advocacy organizations applauds Washington state lawmakers for unanimously passing H.B. 1879 into law.
This new law places guardrails in prescription drug utilization management (UM) protocols and requires a health plan to clearly post the process and criteria for prescription drugs that require a UM protocol, including prior authorization and step therapy. H.B. 1879 establishes an exception process for patients if trying or staying on a medication would create a significant barrier to compliance, worsen a comorbid condition, is contraindicated, or will decrease the patient’s ability to achieve or maintain reasonable function with medication. The new law also unifies timelines for granting or denying submissions on UM to three business days for non-urgent and one business day for urgent cases, with no UM for emergencies.
UM protocols are a set of formal techniques health plans use to evaluate the medical necessity, appropriateness, efficacy or efficiency of patients being able to access treatment. For people living with psoriasis and psoriatic arthritis, prior authorization and step therapy protocols are the most frequently used UM protocols. These protocols are becoming increasingly common across health plans and lack patient guardrails. A study focused on 12 medications used to treat Plaque Psoriasis, Crohn’s, and Colitis found that between 2015 and 2017, employer plans increased the use of UM protocols on these medications from 18 to 56 percent[1]. For patients living with serious or chronic illnesses, such as psoriatic disease, prolonging treatment and delaying access to the right treatment can result in increased disease activity, loss of function, and possibly irreversible damage. Without proper guidelines, UM protocols can limit a health care provider’s ability to tailor care to an individual patient’s needs.
“I have experienced access to care challenges. It can be very frustrating, particularly when you’re already having health issues, and aren’t up to battle insurance provider restrictions,” said NPF Patient Advocate, Kimberly Patton. “I appreciate Washington lawmakers for passing H.B. 1879 so I can work with my health care providers to access the most appropriate treatments for my disease. I look forward to someday obtaining similar legislation at the federal level as well.”
Led by Representative Laurie Jinkins (D-27) and with bipartisan support from the House and Senate, H.B. 1879 will directly impact the ability of the estimated 186,000 plus Washington residents living with psoriatic disease to receive the appropriate treatment and ultimately improve their overall quality of life. The new law will go into effect starting January 2021.
“Our rapidly changing health care landscape often fails to keep the patient at the center of decision making,” said Brittany Duffy-Goche, western region, state government relations manager, NPF. “No longer will Washington state residents be delayed access and forced to try treatments that aren’t right for them. This new law will fine tune the existing system to ensure the process works for everyone that benefits from it.”
NPF played an integral role in the bill’s passing, including coordinating patient testimony and stakeholder meetings. The Foundation has been pursuing this issue in Washington for three years and commends the hard work of our coalition partners in this effort to expand patient access.
NPF continues to work on behalf of all patients 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 utilization management 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 NPF advocacy efforts visit https://www.psoriasis.org/advocacy
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[1] Avalere Health. PlanScape Review of Formulary Coverage of Selected Treatments, 2015-2017. March 2018