Senate committee hears bill limiting 'step therapy' by health insurers – Columbia Missourian

JEFFERSON CITY — Under “step therapy,” patients can be required to take the most cost-effective medicine, with health insurers letting the patient switch to a more costly medication when the first one did not work.

Sen. Doug Beck wants to change that.

Beck, D-St. Louis County, sponsors a bill that would provide more exceptions to the insurance protocol. He said his bill “does not ban step therapy” but will improve it instead. He said the bill will add “specific instances where the therapy will be changed” and will “keep the overall efficiency” of step therapy.

The Senate Insurance and Banking Committee held a public hearing on the bill, Senate Bill 959, Tuesday. It would establish exceptions overriding step therapy in four circumstances:

First, when the step therapy protocol is “reasonably expected” to be ineffective and a delay in treatment will lead to severe consequences.Second, when a condition exists in a patient that will likely make the step therapy treatment harmful.Third, when the step therapy treatment will prevent a patient from attaining a “reasonable and safe functional ability” in their daily and working lives.Fourth, when a patient’s condition is stable while using prescription drugs that have previously received approval for coverage.

Several people with chronic conditions spoke in support of Beck’s bill. 

Susanne D’Angelo, whose 17-year-old daughter has the same incurable chronic condition as she does, said her health insurance provider wanted her to hold her daughter down and inject her with a drug that was “not the right medicine.”

“I can’t do that to my child, so I’m asking you to pass this bill,” she said.

D’Angelo’s doctor, Julie Baak, also testified in favor of the bill. Baak runs a medical center in St. Louis that focuses on autoimmune, inflammatory and chronic illnesses. She said drugs for rheumatology and some other diseases are “not even one size fits most.” Doctors like Baak would make decisions with their individual patients.

“Healers and patients stand together,” she said. “Who are the insurance administrators to insert themselves in that situation?”

Moreover, Baak said she “is so not OK” with step therapy requiring a drug treatment to fail before a patient can use another one.

“When you’re asking a rheumatology patient to fail a therapy, you’re putting them into a flare, you’re causing permanent damage,” she said.

Opponents to this bill included representatives from health insurance companies. Shannon Cooper, a former state representative and current lobbyist on behalf of Blue Cross Blue Shield of Kansas City, said step therapy has “been around for years” and “helps manage the cost.”

For Cooper, passing this bill would make it harder for health insurance companies to control premium prices.

“What you’re gonna find out, you’re gonna have more and more uninsured people in the state,” he said.