Bill would make it easier for patients to get newer drug treatments faster
Posted June 21, 2016
Raleigh, N.C. — The House Insurance Committee will review a bill Wednesday that Doris Ann Price says could have prolonged her life.
Price, who has spent more than 10 years fighting breast cancer and was awarded Tuesday with a courage and dedication award from the National Patient Advocate Foundation, said step therapy has shortened her life because she couldn't receive newer, more effective medications sooner.
House Bill 1048 aims to speed up the process and make it easier for patients and doctors to request particular drugs, rather than having to go through the step therapy process North Carolina law currently requires.
The measure also includes a provision to make it easier for doctors to prescribe abuse-deterrent opioid drugs, such as a new OxyContin formula that can’t be easily broken up and snorted or injected.
Step therapy requires patients to use one or more drugs that are often older, generic versions and have been tested and studied before the patient can use a drug they’d prefer or the doctor suggests, unless the doctor seeks an exception. Step therapy legislation across the United States has been a response to rising costs and widespread commercial advertisements for prescription drugs.
Blue Cross Blue Shield of North Carolina spokesman Lew Borman said the system in place protects patients from potentially risky new drugs and the higher prices that often come with them.
"The whole process starts with the most cost-effective and safest drug therapies available," Borman said. "Newer and more expensive does not always mean better."
Rep. Gregory Murphy, R-Pitt, who sponsored the bill and is a practicing physician, said some insurance companies don't cover what he prescribes.
"(The patient's) insurance company will say, ‘Well, you have to try this first.’ Well, I know point-blank it’s an inferior drug, and that’s not going to work," Murphy said.
The step therapy system allows for exceptions where the physician can formally request to bypass the process, but Murphy argues it’s often time-consuming.
Borman says Blue Cross’ appeals process typically takes three business days if the request is non-urgent or 72 hours if it's urgent. The insurer "does not require step therapy for cancer drugs," he said.
No statistics are readily available on the typical length of appeals processes industry-wide.
"We recognize that there are loud exceptions, but that’s why we have the process," Borman said.