Provisions of the Texas Law
The Texas law reforms, but does not ban, step therapy. This legislation seeks to ensure that an insurer’s process for requesting a step therapy override is transparent and available to the provider and the patient. It creates a process to allow automatic protections from step therapy requirements when patient safety is at risk. These protections apply even if patients have their health insurance changed to a different company or if the company’s formulary changes at contract renewal. The law also allows physicians to request a step therapy override based on the individual patient’s history and that such requests be answered within 72 hours (or 24 hours in special circumstances). The law goes into effect Sept. 1.
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When asked about the lessons learned regarding passage of S.B. 680, Dr. Lakhanpal says, “when you have physicians in every city and county start writing letters, the momentum builds. The grassroots movement activities of contacting our representatives, I think, played a major role.”
It’s important, he and Dr. Molina agree, to engage with one’s legislative representatives. Dr. Molina makes it a practice to hold regular meetings with Texas state representatives and “talk with them about the issues rheumatologists face. Few legislators have a medical background or experience taking care of patients. When they understand the issue, they can act on it.”
Dr. Lakhanpal has been a steadfast supporter of step therapy reform in Texas and across the country. He has promoted the success of the ACR in shaping step therapy reform in fifteen states. Sharing success stories helps build momentum. “Hopefully, other states will follow, because the most important thing is to do the right thing for our patients.” If you are interested in pursuing this type of legislation in your state, contact Hayley McCloud, ACR Sr. Manager of State Affairs.
Gretchen Henkel is a medical journalist based in California.