Step Therapy Legislation Passes in Ohio
posted: February 27, 2019
In a huge win for Ohio advocates, former Governor Kasich signed the step therapy bill into law on January 4, 2019. Patients will now be provided a clear process to override step therapy protocols in the state of Ohio.
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. Thank you to everyone that contributed to the effort.
The new law will impose requirements on health plan issuers that implement a step therapy protocol with regard to exemptions and appeals. Upon the granting of a step therapy exemption or appeal, coverage for the prescription drug prescribed will be authorized if 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; or, if the patient is stable on a prescription drug selected by the provider.
Additionally, health plan issuers are required to 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). The health plan issuer must also 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). And a list of all drugs covered by the issuer that are subject to a step therapy protocol must be made available to all health care providers.
A step therapy exemption request received must be granted or denied within forty-eight hours for urgent care services and ten calendar days for all other requests. Any exemption request that is denied may be appealed by the provider on behalf of the patient, and all appeals must be granted within the same time frames for that of requests. A provider may also appeal any exemption request that is denied.
The OAR will be monitoring the regulatory implementation with the ODI and will keep membership updated on developments.