Committee Recommends Ways to Improve Health and Safety in NC

Raleigh, NC- The House Select Committee on Step Therapy met for its fourth and final meeting today to vote on a recommendation to give to the House during the 2016 Short Session of the General Assembly. The recommendation passed the committee and will be introduced as a bill once the Short Session convenes on April 25th. The recommendation reduces barriers to healthcare across North Carolina and continues a dialogue on how to address the prescription drug abuse epidemic in North Carolina.

The Committee heard testimony from the following individuals:

  • Amber Proctor, Pharm.D., UNC Hospital
  • Diane Kerkhoff, Survivor, Susan G. Komen for the Cure Foundation
  • Chris Evans, Blue Cross Blue Shield North Carolina
  • Ben Twilley, Express Scripts

The recommendation expresses findings about the process of step therapy: a process by which patients have to fail-first and progress through number of drugs that insurance companies require in order to gain access to drugs prescribed by doctors. This portion of the recommendation ensures proper administration of step therapy through requiring clinical practice guidelines that are developed and endorsed by an independent, multi-disciplinary panel that both patients and practitioners have access to a clear, convenient and transparent process to request an override determination which will be granted under certain circumstances.

Rep. Lewis had this to say about the recommendation:

“Ensuring access to healthcare that is responsive to individual medical situations and preserves the doctor-patient relationship is vital to quality healthcare outcomes. Doctors should be making decisions about medications with their patients to prevent lengthy appeals processes with insurance companies and frequent denials by a party that has little knowledge of the specific medical situation. I think this is a great step towards improving access to care for all North Carolinians, especially those vulnerable with life threatening medical conditions.”

The recommendation also addresses the committee’s study of the prescription drug addiction epidemic through the usage of abuse-deterrent opioid analgesics. The recommended legislation states that an insurance policy that provides coverage for abuse-deterrent opioids must treat abuse-deterrent and non-abuse deterrent opioids the same in terms of prior authorization requirements and it cannot require a person to use a non-abuse deterrent opioid before authorizing the use of an abuse-deterrent opioid. Florida has passed similar legislation.

Rep. Lewis also said the following:

“Prescription drug abuse in North Carolina is an epidemic. We are faced with higher healthcare costs, lost work productivity, and a bleeding criminal justice system because abuse runs rampant in many of our communities. I want to thank the committee for taking time to study step therapy and its impact on abuse-deterrent opioid analgesics. It is my goal to reduce the barriers people face to safe and affordable healthcare in North Carolina through legislation that preserves the doctor-patient relationship.”

The Committee was authorized by the Speaker and was charged with the following: The Committee is tasked with studying the prescription benefit management tool known as “step therapy” to assess the impact on patients’ access to care. The Committee shall analyze the costs and benefits of the utilization of “step therapy,” including any potential negative consequences for patients and providers.  The Committee shall also assess the impact “step therapy” has on access to abuse-deterrent opioid analgesics.

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