On May 25, with Gov. Greg Abbott’s signing of Senate Bill 680, Texas became the fourth state this year to increase protection for patients subject to insurers’ step therapy protocols. The State of Texas Association of Rheumatologists (STAR) joined with 35 other professional societies and patient advocacy organizations in urging passage of S.B. 680. The passage of the bill entailed a lengthy process, and enjoyed “widespread bipartisan support,” according to Rep. Greg J. Bonnen, MD (R, District 24), which includes part of Galveston County. Rep. Bonnen authored House Bill 1464, the tandem bill in the House to Sen. Kelly Hancock’s Senate bill.
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According to Rodolfo “Rudy” Molina, MD, president of STAR and a rheumatologist in private practice with Arthritis Associates PA of San Antonio, the state association received notification of the pending legislation in early February. Simone Nichols-Segers of the National Multiple Sclerosis Society, and Hayley McCloud, the ACR state government representative, urged STAR to officially join the consortium of organizations supporting the bill. Dr. Molina and Sharad Lakhanpal, MD, FACR, FACP, ACR president and clinical professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas, contacted their own district representatives to inform them of their support for the bill and urged association members to do the same.
Cost Vs. Patient Benefit
S.B. 680 and H.B. 1464 were drafted to address concerns about insurers’ overuse of step therapy (also called fail-first) protocols, explains Dr. Bonnen—namely that protocols were being driven more by commercial concerns than by scientific evidence. “Patients were encountering scenarios where they’d been on a medication and had been stable for a long period of time—in some instances for years—and then their insurer would change the protocol and potentially force them to change their medicine.”
Dr. Lakhanpal, like many rheumatologists, is all too familiar with the complications and dangers of fail-first therapy. “We know that denying treatment for a patient with inflammatory arthritis for four to six months can cause irreversible joint damage. We have to always think, ‘What is best for the patient?’”
As insurers have increased their use of step therapy protocols to control the cost of expensive drugs, more advocacy organizations have raised concerns about the ethics of the practice. The ACR and other professional medical societies have urged reform so that authorization of medications is based on clinical criteria.