Jul. 28, 2016

Step Therapy Reform

Legislation to address step therapy requirements is close to being signed by the Governor in New York. Similar legislation is underway in Ohio.

Buffalo News

Another Voice: Step Therapy Reform Would Protect New Yorkers

By: Cynthia Rogers

For anyone diagnosed or living with breast cancer in New York, this year has been a remarkable one. Thanks to the efforts of Gov. Andrew Cuomo, the door to access for screening, prevention and treatment has swung open.

Inspired by the diagnosis and treatment of his partner, Sandra Lee, Cuomo took action on behalf of the thousands of New York State residents who will face a cancer diagnosis by pledging $90 million to fight the disease and to make it more affordable and easier for women to get screened.

As a person living with breast cancer, I couldn’t be more grateful for the governor’s pledge to fight against this disease that has affected me, my family and so many other New Yorkers; it’s the right thing to do. Cuomo has another opportunity to help those with a breast cancer diagnosis by signing legislation to ensure patients have access to the most effective and appropriate medications prescribed by their doctors to treat their cancer.

Near the end of this legislative session, both the New York State Senate and Assembly unanimously passed legislation to address the issue of step therapy. You may not have heard the term step therapy, but you may have heard from a friend or relative about being denied a prescription written by a doctor.

In step therapy, doctors prescribe medications based on the individual medical needs of the patient. Patients trying to fill the prescription are sometimes told that the insurer will not cover the cost of the medication until the patient tries and fails on other less-expensive medications, as chosen by the insurer. During this process, insurers rarely consider the patient’s medical history or other health factors, nor is the doctor’s expertise considered.

The newly passed legislation (S.3419C/A.2834D) doesn’t ban step therapy, it simply provides doctors a standardized path to appeal health insurers’ decisions not to fill prescriptions and requires them to respond to the appeal within 24 to 72 hours.

Step therapy doesn’t affect just cancer patients, but a wide swath of chronic conditions. In many cases with cancer patients, it’s not their radiation or chemo that’s put through step therapy, but other supportive medications to fight the side effects of treatment, like nausea or fatigue.

Having recently gone through treatment for breast cancer, at the age of just 46, I know how important having access to these medications is in order to have a good quality of life – while fighting for your life.

I urge the governor to sign this important piece of legislation into law. Doing so is another step forward in the fight against cancer and the fight to ensure all New Yorkers have access to the treatments they need.

Cynthia Rogers, of Buffalo, completed a chemotherapy regimen for breast cancer earlier this month. Her mother has had breast cancer twice.