Step therapy exception authorized

Health care providers will have greater ability to prescribe treatments under a bill passed March 25.

Step therapy is an insurance company practice in which a patient must fail a treatment selected by an insurance company before the company will cover a treatment originally prescribed by the patient’s health care provider. LB337, introduced by Sen. Mark Kolterman of Seward, adopts the Step Therapy Reform Act.

The bill allows a provider to request a step therapy override exception and requires that the override be granted if all of the following apply:
• a provider believes a drug prescribed under step therapy will be ineffective because of the drug’s characteristics or the patient’s experience with the drug;
• a patient previously was prescribed a drug that was ineffective;
• a patient successfully is being treated by a drug prescribed by his or her provider; and
• a drug required under step therapy is contraindicated by the drug manufacturer’s prescribing information or the drug is likely to cause an adverse reaction, decrease a patient’s ability to perform daily activities or cause mental or physical harm to the patient.

LB337 also requires an insurance company to grant or deny a step therapy override within five days of receiving the request except in urgent care situations.

Senators approved LB337 on a 47-0 vote.