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Advocacy

Step Therapy Bill Signed into Law! What Next?

posted: January 8, 2019

Ohio Governor John Kasich has signed the step therapy bill into law! Patients will now be provided a clear process to override step therapy protocols in the state of Ohio. Thank you to everyone who advocated for this measure!

The new law will impose requirements on health plan issuers that implement a step therapy protocol with regard to exemptions and appeals. OAR staff will be working to put together helpful materials for physicians to use in office once the new law takes effect on April 3, 2019.

Below outlines the law as written:

Upon the granting of a step therapy exemption or appeal, coverage for the prescription drug prescribed will be authorized if any of the following are met:

  • The patient has tried the required prescription drug while under their current, or previous health benefit plan and such prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event.
  • The patient is stable on a prescription drug selected by the provider.

Health plan issuers are required to do the following:

  • Make available to providers a clear, easily accessible, and convenient process for requesting a step therapy exemption on behalf of a covered individual (a step therapy exemption request made by the provider will require supporting documentation and rationale).
  • Indicate what information or documentation must be provided for a step therapy exemption request to be considered complete (the information required must be available on the issuer's web site or provider portal, and the requirements may vary by drug).
  • Make available, to all health care providers, a list of all drugs covered by the issuer that are subject to a step therapy protocol.

A step therapy exemption request received must be granted or denied in the following time frames:

  • Forty-eight hours for a request related to urgent care services
  • Ten calendar days for all other requests

*A provider may, on behalf of the covered individual, appeal any exemption request that is denied.

Appeals must be granted or denied within the following time frames:

  • Forty-eight hours for appeals related to urgent care services
  • Ten calendar days for all other appeals

*A provider may, on behalf of the covered individual, appeal any exemption request that is denied.

The law does not prevent either of the following:

  • A health plan issuer organization from requiring a patient to try any new or existing pharmaceutical alternative, per the federal food and drug administration's orange book, purple book, or their successors, prior to providing or renewing coverage.
  • A health care provider from prescribing a prescription drug, consistent with medical or scientific evidence.

READ THE FULL BILL