Legislation Filed To Ensure Tennessee Patients Faster Access To Effective Medicine

Feb 03, 2020 at 12:16 pm by Staff

Tennesseans for Affordable Access to Medicine, a coalition comprised of thousands of patients, healthcare providers and caregivers, today lauded legislation that would allow Tennessee patients faster access to more effective medical treatment as prescribed by their doctor.

The bill, HB1866/SB1935, is sponsored by Sen. Art Swann (R-Maryville) and Reps. Mark Hall (R-Cleveland), Esther Helton (R-East Ridge) and Robin Smith (R-Hixson) and aims to reform step therapy protocols.

"Step therapy can undermine the relationship between doctors and their patients and often prevents patients from getting the medication they need for effective treatment," Sen. Swann said. "This bill just makes sense. It allows patients access to the treatment their doctor believes is best."

"Controlling costs in healthcare is important, but so is ensuring Tennesseans are getting the treatment they need," Rep. Hall said. "I encourage my colleagues to consider the positive impact of this legislation in balancing cost with effective patient care."

The step therapy process, also known as "fail first," is currently used by insurance companies to review the use of prescription drugs in an attempt to control costs. Through step therapy, a patient may be required to try, then fail, on alternative drugs selected by their insurance company before coverage is granted for the drug prescribed by the patient's health care provider. The protocols of this process limit a health care provider's ability to tailor care to individual patient needs.

"The Arthritis Foundation applauds Reps. Hall, Smith, Helton, and Sen. Swann for introducing legislation that will put reasonable patient protections in place so patients can access the most appropriate therapies recommended by their doctors," Kristen Crawford, state director, advocacy and access for the Arthritis Foundation said.

"We are grateful to Sen. Swann and Reps. Hall, Helton and Smith for introducing this bill," Emily Ogden, director of government relations for the American Cancer Society Cancer Action Network (ACS CAN), said. "Delayed access to the right treatment can put patients with serious or chronic illnesses at risk and increase overall health care costs over time."

Step therapy protocols vary widely among insurers, from the number of steps a patient must cycle through, to the duration a patient must try the insurer's selected medication(s) before they can access their healthcare provider's first choice of treatment.

The proposed legislation does not ban the practice of step therapy in Tennessee but provides exceptions when warranted. The legislation puts safeguards in place around the insurance industry practice of "fail first" to ensure that patients have timely access to critical medications without unnecessary interference from insurance companies.

More than 20 states, including Georgia and Virginia, have enacted legislation limiting step therapy in critical situations, while still allowing insurers to use step therapy when it is medically appropriate.