The Maine Senate on Thursday approved new regulations that would limit so-called “step therapy,” a practice that patient advocates criticize for being harmful to patients by denying them the medication that works best for them.
Step therapy – also known as “fail first” – mandates that patients try certain, usually less expensive, drugs before moving to more costly medications that treat the same condition.
The policies help control costs, but advocacy groups have argued that in some cases the policies bar effective medications for patients. In some cases, patients must repeatedly go through step therapy.
If Gov. Janet Mills signs the bill – the House previously approved it – Maine would join 24 states that have similar statutes on the books. The bill would not ban step therapy, but establish rules, such as setting up a process for doctors to override insurance company decisions on medications, and ensure that fail-first policies are transparent. The measure would also limit other practices, such as making patients go through step therapy repeatedly.
Mills spokeswoman Lindsay Crete said the governor is reviewing the bill and will make a decision within the next 10 days.
“Governor Mills believes that Mainers should be able to access critical medications free from unnecessary burdens and will consider all reasonable and safe ideas to help accomplish that,” Crete said in an email response to questions.
A broad coalition of medical and patient advocacy groups supported the bill, L.D. 1009, including doctors, nurses, the AARP and a number of nonprofit organizations, such as the American Heart Association, American Lung Association and the American Diabetes Association.
“We are grateful to lawmakers for understanding the need to protect patients and put medical decision-making in the hands of doctors, not insurers,” Hilary Schneider, Maine government relations director for the American Cancer Society Cancer Action Network, said in a statement. “This is important to thousands of patients who are already suffering enough.”
“This law will help expedite access to much-needed treatment for patients,” Amy Prentice, associate director of state government relations for the National Psoriasis Foundation, said in a statement. “That’s why nearly half the states in the country have already enacted similar legislation.”
Insurance industry representatives spoke out against the bill, arguing that it would add costs to the system.
The bill was sponsored by Rep. Charlotte Warren, D-Hallowell, and Sen. Heather Sanborn, D-Portland.
“This is such a welcome relief,” Brooke Cooper of Portland, whose 16-year-old daughter, Liv, has a rare form of epilepsy, said in a statement. “We had to go through months of waiting, fear, and delays in treatment. I’m thrilled lawmakers heard our voices and made reforms so that others don’t have to suffer like Liv did.”
Send questions/comments to the editors.
