Florida Senate Bill 98 would begin to rein in harmful ‘step therapy’ and prior authorization insurance practices

12.7.17

12.07.17

A bill advancing in Florida would make it easier for patients to get the medications their physicians prescribe.

If passed, Senate Bill 98 would reduce the time insurance companies have to approve prior authorization requests. S.B. 98 would also address “step therapy,” or “fail first,” practices. Step therapy occurs when an insurer, HMO or pharmacy benefit manager requires a patient to try a different, cheaper treatment than what their doctor prescribed and to fail on that treatment before they’re allowed to obtain the one recommended by their physician.

Senate Bill 98 would shorten the timeline for insurers to respond to doctors’ requests for prior authorization when prescribing drugs for their patients. For urgent requests, the deadline would remain 24 hours, but for nonurgent requests insurers would have three days rather than two weeks to let a patient know if their treatment or needed service will be covered.

In addition, the bill would create exceptions requiring insurance companies to cover a treatment – eliminating the possibility of step therapy – when taking the insurer’s preferred, cheaper drug would worsen a patient’s medical condition or would interfere with their ability to carry out routine tasks and daily activities.

An increasing number of insurance companies have established prior authorization and step therapy policies to limit patients’ use of certain medications and treatments, especially those used for chronic diseases, to avoid paying for more expensive patients’ needs. These practices can have catastrophic effects on a patient’s health and on our health system overall.

Natalie Blake, director of program services for the Multiple Sclerosis Foundation, told Florida senators that step therapy is especially harmful for people with progressive and chronic health conditions.

“In MS, if you fail a drug, it results in further disability,” she said, according to an article by Health News Florida. “You have more progression of your disease and, in the long run, it results in a lot more costs to the health system.”

Blake called on Florida lawmakers to protect patients’ access to treatments approved by the Food and Drug Administration and prescribed by their doctors.

”It’s unconscionable for somebody with a disease like multiple sclerosis to have to fail a drug first,” she said, according to Health News Florida.

Last year, a similar bill, Senate Bill 530, was passed by the Florida Senate but later failed in the House of Representatives.

Senate Bill 98 was filed for the 2018 legislative session, which starts next month. The Chronic Disease Coalition is among dozens of patient and health advocacy organizations supporting S.B. 98, such as H.E.A.L.S of the South, the American Cancer Society, the AARP, BioFlorida, the US Rural Health Network, Epilepsy Association of the Big Bend and the Florida Medical Association, as it moves through the Florida Legislature.