By Shaina Smith
New York Governor, Andrew Cuomo has signed a bill that overrides the unfair practice of “step therapy,” which is known as a “fail first” approach that insurance carriers use to force people to use the least expensive drug in any class to be used first, even if a patient’s physician believes a different therapy is medically appropriate.
It took years of advocacy to appeal step therapy in the state. This past year, over 80 patient and provider groups, including U.S. Pain Foundation, banded together to collaborate on initiatives which raised awareness surrounding both step therapy and the proposed legislation by Assemblyman Matthew Titone and Senator Catharine Young. The Assembly and Senate unanimously passed S.3419C, a bipartisan bill designed to create a clear override process for doctors who feel that “failing first” on alternative therapy options could pose negative impacts to their patients.
“We are pleased that Governor Cuomo has once again shown his support for pain patients and anyone in need of their treatments to manage their condition,” said founder and president of U.S. Pain, Paul Gileno. “Patients deserve timely and medically necessary treatments without insurance companies interfering with their treatment plan. This newly passed law will ensure access hurdles are easier to overcome, thanks to a more transparent process in place.”
This law will not ban step therapy, but will deter the harmful practice from taking place to legitimate pain patients. Under the bill, insurers must respond to step therapy appeal requests within 72 hours and 24 hours in emergency situations to prevent unnecessary delays in critical care for patients. The bill also includes standards or guardrails around exception processes.
“Without protections, step therapy can lead to significant, negative consequences for a person living with pain, or any New York resident who has been prescribed a treatment option to manage a condition,” Gileno added. “By Governor Cuomo’s signing of S.3419C into law, the state of New York is clearly stating that residents with chronic pain and/or a mental health condition should have access to the treatment plan determined from their medical team.”
New York now joins several other states who have approved patient protections against step therapy including Connecticut, Illinois, Indiana, Kentucky and Missouri.
Shaina Smith is Director of State Advocacy & Alliance Development for U.S. Pain Foundation. Diagnosed with various pain conditions, including Ehlers-Danlos Syndrome Hypermobility Type, Shaina utilizes her Journalism background to mobilize pain patient advocates and engage volunteers to participate in awareness programs.