This article is more than 5 years old. Information may no longer be current.
Rheumatology nurses' voices key to passing step therapy reform
ORLANDO — Testimony and letters from rheumatology nurses have been instrumental in helping to pass step therapy reform in 26 states across the United States, with advocacy groups eyeing at least seven more statehouses for similar efforts next year, according to Michele Guadalupe, MPH, development director of the Arthritis Foundation’s Advocacy Alliance.
“We have had significant wins in the states, and that is because of experts like you,” Guadalupe told attendees at the 2019 Rheumatology Nurses Society Annual Conference. “Many of you, and many of your colleagues, have stepped up: you have written letters, you have gone and testified, and you have helped work with your patients. All of that has really made an impact. I have been in so many hearings where the legislators want to hear from all of you.”
According to Guadalupe, the Arthritis Foundation is working in coalitions at both the state and federal level to spread step therapy reform. This includes legislation that promotes transparency in the step therapy process and allows providers to override step-therapy decisions in certain situations, she said. In addition, legislation can also require health plans to follow a clear and timely review of override requests.
As of July 11, 2019, state-level step therapy legislation has been enacted in Maine, New Hampshire, New York, Connecticut, Delaware, Maryland, Virginia, West Virginia, Georgia, Ohio, Indiana, Kentucky, Michigan, Illinois, Minnesota, Iowa, Missouri, Arkansas, Mississippi, Louisiana, Oklahoma, Texas, Colorado, New Mexico, California and Washington.
According to Guadalupe, there are active step therapy reform bills in seven other states — Massachusetts, Rhode Island, Pennsylvania, North Carolina, Florida, Kansas and Oregon — that have not yet been approved.
“Those seven states are examples of states where we haven’t yet been able to get across the finish line in this legislative session, but we are currently determining our 2020 target states,” Guadalupe said. “Know that many of those states are places where we will be going back to in 2020. We are also considering some additional states.”
At the federal level, the Safe Step Act (H.R. 2279) was introduced in the House of Representatives in April 2019 by U.S. Rep. Brad Wenstrup, R-Ohio, who is also a podiatrist, as well as Rep. Raul Ruiz, D-Calif., who is a physician.
The two legislators had in 2017 introduced a similar bill during the last Congress that attracted 88 cosponsors in the House but did not have a companion version in the Senate. The new bill, which had 83 cosponsors as of August 2019, would call for a transparent process to seek exceptions to step therapy review by health plans, and create a clear timeframe for override decisions. In addition, it would require insurers to consider patients’ medical history and provider’s expertise, as well as input from the patient, in all step therapy decisions.
According to Guadalupe, a new bill in a new session of Congress requires advocates to put in more work to rebuild support.
“Things at the federal level do sometimes move quickly — sometimes,” she said. “However, we know that collective voice actually does make an impact, so have more than 1,200 letters now from our advocates, and we know that these letters influenced as many as 67 sponsors to join the bill.” – by Jason Laday
References:
Guadalupe M. Step therapy reform. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 7-10, 2019; Orlando, Florida.
Disclosure: Guadalupe reports no relevant financial disclosures.