Governor signs medical ‘fail first’ reform legislation

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From The Bulletin, the Mercury’s blog, where we post quick hits on the news of the day, odds and ends and commentary.

Past efforts to reform step therapy in Virginia have been met with resistance from health insurance companies. But this year’s bipartisan push to reform the practice — which can force patients to take medicines their doctors don’t think will be effective before they get clearance from insurers for pricier drugs — was unanimously approved by both chambers in the General Assembly.

Gov. Ralph Northam signed the new legislation Tuesday.

Step therapy, also known as “fail first” protocols, require patients to try and fail some medications before an insurance company will cover the drug originally prescribed by their doctor. Insurers say it helps rein in costs.

The legislation, sponsored by Del. Glenn Davis, R-Virginia Beach, creates several reforms to step therapy practice in Virginia, like requiring the protocols be developed and endorsed by a a multidisciplinary panel of experts and continually updated to reflect new evidence and research. It also requires the insurer to provide a “clear, readily accessible and convenient process to request a step-therapy exception” when a patient has been prescribed a drug subject to step therapy.

The new legislation makes Virginia the 20th state to reform step therapy, according to a news release from Fair Health Care VA, a chronic health advocacy group.

“This legislation will help patients receive appropriate therapies when their unique circumstances need personalized treatment and ensure that the patient-physician relationship remains at the center of care decisions,” Dr. Harry Gewanter, a pediatric rheumatologist in Richmond and advocacy chair of the Arthritis Foundation’s Virginia chapter, said in a statement.

Williamsburg resident Tom Ema testified before the General Assembly in favor of the legislation, explaining that he was required to fail the same chemotherapy drug several times for his stage four lymphoma before he could get the medication he needed, which ultimately cured him.

“As a patient who has experienced step therapy, I know how important it is for patients to have access to the high-quality care they need, not just the treatment that happens to be cheapest,” he said in the release.