Step Therapy Override Bill Supporters Seek Consensus

2015-08-04 | , California Rheumatology Alliance

August 3, 2015 – As the end of the 2015 state legislative session draws near, stakeholders continue to work toward a compromise on the CRA and Arthritis Foundation co-sponsored legislation (AB 374) which will create a uniform step therapy override determination request form and process.  

AB 374 (Nazarian) successfully passed the Assembly and most recently passed the Senate Health Committee, with amendments, on July 15, 2015 by a vote of 7 to 2.  CRA members contacted Committee members in advance of the hearing voicing their support. 

The latest version will require the Departments of Insurance and Managed Care Health to design a step therapy override determination request form.  If a prescriber determines that a prescription drug required pursuant to a step therapy or fail-first protocol by the health insurer is not in the best interest of the patient, based on medical appropriateness, then the prescriber may use the form to make an step therapy override determination request to a health insurer.  Once the form is implemented, health insurers will be required to approve or deny a step therapy override determination request form within 72 hours for non-urgent requests, and within 24 hours if exigent circumstances exist.  This expedites the process as under current law decision may take up to 30 days.  If a health insurer fails to utilize or accept the override request form within the 24 or 72 hours, depending on exigent circumstances, then the override request must be deemed granted. 

The bill is expected to be heard in the Senate Appropriations Committee after summer recess ends on August 17.  Additional changes may be considered to remove opposition.  If the bill passes the Senate, the Assembly must approve of any amendments before it may be sent to the Governor for his consideration.  

CRA supports legislation limiting fail first and step therapy policies, ensuring that patients have access to their lifesaving medications and streamlining administrative simplification for the physician's office.