Lewis Introduces Legislation to Limit Insurer Practices that Keep Patients from Accessing Medications

Rep. David Lewis and Rep. Michael Wray Introduce Legislation to Limit Insurer Practices that Keep Patients from Accessing Medications

HB 821 Imposes Limits on Step Therapy & Fail-First Practices Limiting Treatment for MS, Diabetes, Psoriasis, Arthritis & Other Conditions

(RALEIGH, N.C.) – April 15, 2015 – Rep. David R. Lewis and Rep. Michael H. Wray today announced the introduction of legislation aimed at ensuring that thousands of North Carolina patients have access to the medications prescribed by their physicians. HB 821 limits insurance industry practices known as step therapy or fail-first protocols, whereby patients are forced to try and fail on a series of treatments before they are given access to the medication recommended by their physician.

“Step therapy and fail-first protocols have become increasingly pervasive tactics to discourage access to the most effective treatments for multiple sclerosis, diabetes, psoriasis, arthritis and a range of other chronic and even life-threatening medical conditions,” said Rep. Lewis. “Instead of taking the treatment originally prescribed by their doctors, patients across North Carolina are being required to try and fail on a variety of less effective medications. Meanwhile, their conditions can get worse or even require hospitalization.”

Rep. Lewis continued, “HB 821 goes a long way toward making sure that treatment decisions stay in the hands of physicians and their patients. The legislation helps guarantee that insured North Carolinians will be able to access the treatments they need without delay.”

HB 821 establishes limits for step therapy and fail-first protocols by requiring that each step therapy or fail-first protocol be based on clinical practice guidelines that meet a range of patient- and provider-centered requirements. It also establishes a clear process for health care providers to request exceptions for step therapy protocols, and requires the exception to be provided if the physician determines that the insurer-required drug is not in the best interest of the patient.

House Bill 821 Proper Administration of Step Therapy has been referred to the Heath Committee in the North Carolina House of Representatives for consideration. Rep. David R. Lewis is the Chairman of the Committee on Rules, Calendar, and Operations of the House.

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