Pain Sufferers in New York Ring in the New Year with Appeal of Step Therapy Law

Pain Sufferers in New York Ring in the New Year with Appeal of Step Therapy Law

By Shaina Smith


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.

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Authored by: Shaina Smith

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I think this is a step in the right direction. Hopefully it will continue. What pain suffered need is the ability to be a part of the decision making process. We know our bodies better than anyone else. We know what works and what doesn’t. We’ve got to keep up that good fight!


Perhaps things might change if the lawmakers suddenly were faced with incurable chronic pain conditions and their physicians told them about the limited or completely denied access to the right medicines.


Tell you the truth IMO the witch hunt on opioids is due to Big Insurance wanting to purge the costly chronic pain patients from their rolls. This is also why medical MJ stays at schedule 1 so to have those who are helped by MJ to pay out of pocket. Stop the insanity and take profit out of healthcare. Single payer would help a hell of a lot of people.

Good going Andrew! Your Dad would be proud of you!


This is a significant achievement and serves to empower people in pain to make their own decisions.
Its remarkable how people in pain are forced to go to lawmakers to compel insurers and providers to treat them with respect and honor their autonomy. Insurers have been remarkably selfish and uncaring toward people in pain and have sought to make as much money as possible from people in pain and ignore their suffering. Insurers market fundamentalism and greed has not only been a detriment to people to people in pain- but to the people who care about them and rely on them.
Lets not stop here with insurers- lets get them to pay for better treatments and lets have a review board consisting of people in pain to review denials from insurers.
In addition we will need a review board to review decision providers make regarding providing opioids and other treatments.
The pain community has come to realize market fundamentalism and government have been detrimental to them and added greatly to their suffering. We need to march forward toward obtaining a humane and effective pain care system that places people in pain in the center of decisionmaking regarding their own care. Failing that, greedy and proud market fundamentalists in insurance field and the health care field will diminish the rights of people in pain for the sake of power, position, and profits.


I suppose that a little is better than nothing. Why not just get rid of the STEP programs completely? The government and insurance companies need to remember that they don’t have a licence to practice medicine and even if they did I am not their patient!


If a physician prescribes a medically inadvisable medicine and the results are terrible for the patient, either horrible side effects, allergic reaction to a filler or the drug itself, or an irreversible setback in treatment, can the patient and/or physician sue the insurance company? Law suits might be the only way to end this practice, if private medical insurance continues to reign supreme.