SUPPORT: Step Therapy Reform
SB 1310/HB 2447
Sen. Joey Hensley, MD (R – Hohenwald), Rep. Mark Hall (R – Cleveland)
What the Bill Does: Specifies conditions in which a health plan must grant exceptions to the step therapy protocol, including when the drug is contraindicated or may cause an adverse reaction; the drug is expected to be ineffective; the patient has already gone through step therapy under a different health plan; or the patient is stable on a drug covered by a previous health plan.
Why the Bill is Needed: The step therapy process, also known as “fail first,” is commonly used by insurance companies to review the use of prescription drugs in an attempt to control costs. These protocols limit a health care provider’s ability to tailor care to individual patient needs and can delay care. This legislation would establish safeguards to ensure that patients have timely access to critical medications without unnecessary interference from insurance companies.