A congressional effort to improve patients’ access to treatment is generating widespread enthusiasm in the advocacy community. Sponsored by Rep. Brad Wenstrup, DPM, (R-Ohio) and Rep. Raul Ruiz, MD, (D-Calif.), the Restoring the Patient’s Voice Act of 2017 is a first-of-its-kind bill that protects patients’ ability to access the medications their doctor prescribes.
The bill tackles step therapy, a cost-cutting technique whereby insurers require patients to fail on an inexpensive treatment preferred by the health plan before getting the medication prescribed.
After years of appealing to one state legislature after another to address the issue at the state level, patients and advocates are excited to have a federal effort underway. In a letter signed by the Alliance for Patient Access and 27 other patient advocacy and health care provider organizations, supporters praised Rep. Wenstrup and Rep. Ruiz’s “leadership and foresight on the issue.”
“When health care plans seek to interfere with that decision-making and change the course of treatment, it jeopardizes a patient’s well-being,” the letter explained, “regardless of the disease state or medical concerns being treated.” The letter’s signers represent a diverse cross-section of disease states and therapeutic disciplines, including oncology, infectious disease, rheumatology and autoimmune diseases, dermatology and neurology.
HR 2077 would require employer-sponsored health plans to have a straightforward exception process for bypassing step therapy requirements when necessary. That includes listing exceptions on the insurer’s website, providing an explanation of the exception process and making any necessary forms available.
The bill also lays out automatic exceptions, such as situations in which a patient has already tried and failed a drug under a previous health plan. In addition, the bill dictates a defined timeline of three days for exceptions – 24 hours when the patient’s health is in danger.