(February 8, 2017) Representatives from more than 50 patient and provider groups across Ohio gathered at the Statehouse to declare “Fail First February” in an effort to raise awareness of the insurance industry practice known as “fail first” or “step therapy”. The “Ohio Coalition to Reform Step Therapy,” which includes the Ohio Osteopathic Association, is comprised of patient groups, physician organizations and pharmacists.
State Sens. Peggy Lehner (R-Kettering) and Charleta Tavaras (D-Columbus) have introduced SB 56 to protect patients under “Step Therapy/Fail First” protocols used by health insurers to limit costs for medication. State Reps. Terry Johnson, DO (R-McDermott), and Nicki Antonio (D-Lakewood) are cosponsoring a companion bill in the Ohio House of Representatives.
OOA Executive Director Jon F. Wills, introduced legislative sponsors during a Feb. 8 news conference at the Statehouse, followed by visits to the House and Senate to obtain co-sponsors. Shannon Trotter, DO, president of the Ohio Dermatological Association, was one of two physicians presenting during the news conference.
Step therapy is a cost savings tool used by health insurers that forces patients to take and fail on medications other than what their doctor has prescribed, before their insurer will cover the cost of the original medication.
Step therapy protocols can be harmful to patients both financially and physically, causing an undue wait for the proper treatment and in some cases a worsening of a person’s medical condition. Step therapy does not take into account an individual’s medical history or other factors, but instead relies upon a pre-determined prescription drug formulary or protocol.
Legislation has recently been re-introduced from last session, to reform step therapy protocols. The bills will give doctors a transparent and standardized process to appeal step therapy requirements for patients needing a particular treatment. The bill does not ban step therapy, or the number of steps an insurer can implement. Patients may still need a prior authorization from their insurers.
“It is my great hope that we can raise awareness of the potentially dangerous practice of ‘fail first’ protocols’,” said Kenton Beachy, Executive Director of Mental Health America of Franklin County. “People with psychiatric disorders need to have access to the medications their doctors believe are the most appropriate for them. Improper use of medication can lead to negative and expensive outcomes such as emergency room visits, hospitalizations, possible entry into the criminal justice system, and in the most tragic examples, even death.”
More information about fail first/step therapy protocols and its impact on patients is available at https://www.facebook.com/ohioanssteptherapyreform/ .