Rep. Brad Wenstrup
Medical providers would have more power to determine appropriate treatments for the patients under bipartisan legislation recently introduced by U.S. Rep. Brad Wenstrup (R-OH).
The Restoring the Patient’s Voice Act would curb employer-sponsored health plans’ use of “step therapy” in which insurers require medical providers to try alternative, less expensive treatments before approving costlier options.
“While step therapy can guide patients toward less costly treatments, too often it serves as a roadblock to getting patients the treatment they truly need,” Wenstrup said. “Instead of a one-size-fits-all policy that ignores a patient’s medical history or medical conditions and overlooks a doctor’s recommendations, we need a way to streamline the process for patients who require more individualized care.”
Employer-sponsored health plans using step therapy would be required to develop and implement a clear, standard practice for patients and medical providers to request exceptions, and the bill identifies certain circumstances that would qualify for an automatic exemption.
“The Restoring the Patient’s Voice Act will make the process for requesting a step therapy exception faster, easier and more transparent,” Wenstrup said. “The doctor-patient relationship is a cornerstone of quality health care and working to restore it in this way benefits all Americans.”
The measure would grant automatic exemptions if a required drug is contraindicated, a patient has already tried a required drug, a required drug is reasonably expected to be ineffective, a required treatment is likely to cause an adverse reaction, or a required treatment is not in the best interest of the patient.
Dr. Geraldine Urse, the president of the Ohio Osteopathic Association, said physicians do not want to write a prescription for a medication that patients are unable to obtain due to costs.
“However, there are times when, because of a patient’s unique medical history, a particular medication must be prescribed,” Urse said. “Insurers are increasing their use of step therapy requirements, which vary from insurer to insurer and with procedures that change frequently. These requirements result in physicians and staff spending hours attempting to obtain needed medications for patients.
Reforming step therapy, she said, would help achieve standardization, transparency and a streamlined process for physicians to override requirements and get the medicines patients need.
U.S. Rep. Raul Ruiz (D-CA), who introduced the bill with Wenstrup, said it would ensure patients have access to treatments to meet their specific needs. “As a physician, I know that each patient has unique needs and responses to different types of treatments or medications,” Ruiz said. “This bill ensures a patient-centered focus to step therapy protocols.”