As we ring in the new year, we celebrate a major step therapy legislative win in New York! An increasing number of health insurers around the country are utilizing fail first or step therapy practices that require patients to try and fail one or more formulary medications before providing coverage for the originally prescribed non-formulary medication. Rather than taking into account the needs of the individual patient, insurers are determining drug sequences based on cost. These practices can vary wildly insurer to insurer with no consistency on how to establish or apply these fail first protocols.
As a result, step therapy practices can lead to delays in access to the medications that offer the greatest potential medical benefit to people with arthritis. Since arthritis is a chronic and degenerative disease, delays in treatment can worsen disease progression and even cause permanent damage and disability. Additionally, required fail first drugs may cause adverse reactions or complications to the patient due to side effects.
纽约州州长安德鲁·科莫(Andrew Cuomo)于新年前夜签署的法案(S3419C)包括两项基本的患者保护措施，将提高步进治疗协议的安全性和有效性。首先，它要求保险公司用于建立“先失败”协议的临床审查标准以科学和循证临床实践指南为基础，而不是完全由成本驱动。其次，该法案要求医生和其他处方者可以使用一个清晰而快捷的程序来请求推翻“先失败”的方案。
Many Arthritis Foundation Ambassadors, including Erin O’Rourke, played key roles in passage of the bill sponsored by Republican Senator Catharine Young and Democratic Assemblyman Matthew Titone. Erin wasfeaturedin a story on local network television station Fios Long Island in November. In the interview, she explained how step therapy insurance practices can impact patient’s lives and employment, saying, “If you switch a job, you have to start all over again.”
“This is a significant victory for the New York arthritis community,” said Sandie Preiss, national vice president for the Foundation’s Advocacy & Access program. “This legislation is crucial to protect those patients facing severe illness by ensuring timely access to the right medications. It’s the result of tireless work by our Advocates and continuous support from New York’s legislators and Governor Cuomo.”
This legislation will help the nearly four million New Yorkers who live with doctor-diagnosed arthritis receive timely access to the correct medication. Thanks are due to many otherAdvocatesand Ambassadors who worked for passage of the bill by sending letters, making phone calls and submitting videos throughsocial mediato the Governor’s office urging him to sign this bill.
如果没有像你这样的关节炎患者的参与和支持，这些重要的胜利是不会发生的!Get involved by attending the 2017Advocacy Summit, March 6-7, in Washington, DC.