Lagging again are Iowa and Minnesota, with a five-day requirement, while Ohio has a 10-day requirement that will go into effect on Jan. 1, 2020. While these response times are far from desirable, they still provide some timeline, even though they will still result in delays in care for patients.
Override for Previously Failed Steps
One of the most important provisions of any step therapy bill is the inclusion of an automatic exception for a patient who has previously failed a step. This protects patients from having to repeat medications that have already proven to be ineffective for them. Twenty-one states currently have this exception in their state laws, with Georgia, Ohio and Wisconsin’s protections becoming effective on Jan. 1, 2020. Washington state’s will again go into effect in January 2021.
Override for Contraindication
Of all the override exceptions, this may seem like the most obvious: A patient should not take a drug that would likely cause them harm. While this may seem like a common-sense exception, its inclusion in step therapy laws is far from universal. Twenty states currently have an exception for contraindications. Georgia, Ohio, Oklahoma and Wisconsin’s provisions will go into effect in January 2020, while Washington’s will go into effect in January 2021.
Override for Stable Patients
Again, this may seem like a common-sense override exception, but only 15 states currently have overrides for stable patients. This is a particularly important exception for patients who are stable on a biologic. As you likely know, many patients who are stable on a biologic may not respond the same if they are switched to a different drug and then try to switch back to the original biologic. Although we cannot fully explain this phenomenon, we do know how to prevent it: Do not require stable patients to switch medications.
Your Role in Changing the Conversation
As a physician, you are not only a trusted resource for your patients, you are also capable of being a trusted resource for your local legislator. State legislators often depend on local experts from their districts for advice on complex issues like health policy. It is important for you to get to know your local legislative delegation where they live and work.
District meetings are one of the best places to establish meaningful and impactful relationships with legislators. You may often find yourself meeting them at a local coffee shop or restaurant instead of in an office. This kind of personal meeting has proven time and time again to be more effective than capitol office meetings. The legislator may be more relaxed and receptive, and may have more time than during a typical office meeting.
