New York Governor Andrew Cuomo has signed into law a bill that protects patients from step therapy, marking a victory for advocates in the state. The bill allows physicians to appeal insurers’ “fail first” requirements, which ask patients to fail on a cheaper medicine before receiving their prescribed treatment.
[WATCH: Understanding Step Therapy]
Under the new law, health plans must cite clinical review data to justify why they think a patient won’t benefit from the prescribed medication. When physicians appeal step therapy requirements, health plans have 72 hours to respond; 24 hours for emergency situations. The law goes into effect this year, despite complaints from health plans that it will increase the state’s prescription drug costs.
New York Assemblyman Matthew Titone explained that Gov. Cuomo’s signature means, “doctors and patients will be assured that the medical needs of all are put ahead of the bottom line of insurance companies.” Titone sponsored the bill in the New York Assembly, while Senator Catharine Young sponsored legislation in the state senate.
The bill received accolades from The Global Healthy Living Foundation, National Psoriasis Foundation, and Lupus & Allied Diseases Association, which rallied for step therapy legislation in New York for six years. The Global Healthy Living Foundation heralded the governor’s signature as a “historic action to protect New Yorkers battling chronic disease.” U.S. Pain Foundation also praised the law, applauding it for protecting pain patients’ access to prescribed treatments.
Step therapy has been criticized for imposing a one-size-fits-all approach to patient medications and for undermining physicians’ judgement. It can also delay patients’ access to the most effective treatments, causing patients to suffer sometimes irreversible damage. Yet, according to Health Affairs, use of step therapy rose from 27 percent in 2005 to 73 percent in 2013.
New York now joins Indiana, Missouri, and Illinois in protecting patients from fail first requirements.