Governor Cuomo signs S.3419C into Law
Middletown, CT, January 1, 2017– After years of advocating for a transparent and standardized process to appeal step therapy, an insurer protocol which forces patients to fail on a series of medications before receiving the originally prescribed treatment, New York state Governor Andrew Cuomo has signed a bill into law which overrides the unfair insurer practice.
This past year, over 80 patient and provider groups, including U.S. Pain Foundation, banded together to collaborate on initiatives which raised awareness surrounding both step therapy and the proposed legislation by Assemblyman Matthew Titone and Senator Catharine Young. The Assembly and Senate unanimously passed S.3419C, a bipartisan bill designed to create a clear override process for doctors who feel that “failing first” on alternative therapy options could pose negative impacts to their patients.
“We are pleased that Governor Cuomo has once again shown his support for pain patients and anyone in need of their treatments to manage their condition,” said founder and president of U.S. Pain, Paul Gileno. “Patients deserve timely and medically necessary treatments without insurance companies interfering with their treatment plan. This newly passed law will ensure access hurdles are easier to overcome, thanks to a more transparent process in place.”
This law will not ban step therapy, but will deter the harmful practice from taking place to legitimate pain patients. Under the bill, insurers must respond to step therapy appeal requests within 72 hours and 24 hours in emergency situations to prevent unnecessary delays in critical care for patients. The bill also includes standards or guardrails around exception processes.
“Without protections, step therapy can lead to significant, negative consequences for a person living with pain, or any New York resident who has been prescribed a treatment option to manage a condition,” Gileno added. “By Governor Cuomo’s signing of S.3419C into law, the state of New York is clearly stating that residents with chronic pain and/or a mental health condition should have access to the treatment plan determined from their medical team.”
New York now joins several other states who have approved patient protections against step therapy including Connecticut, Illinois, Indiana, Kentucky and Missouri.
ABOUT STEP THERAPY
Known as “fail first”, step therapy is an insurance practice which requires the least expensive drug in any class to be prescribed to a patient first, even if a patient’s physician believes a different therapy is medically in the best interest of their condition. Patients, including those with serious and degenerative medical conditions, can be forced to prove that cheaper and often less effective treatments have failed to adequately treat a patient’s condition for an indefinite period of time before the treatment initially prescribed by the physician is paid for by the insurance company.
U.S. Pain Foundation believes when step therapy stands in the way of treatments that are medically necessary, patients and their health care providers should have access to a clear and speedy process for seeking an exemption from an insurer’s step therapy protocol.