On November 15th, ASBM Chairman Ralph McKibbin, MD moderated a panel discussion at the Digestive Disease National Coalition’s Fall policy-setting forum.
The Fall Forum ran from November 15th-19th and gathered together policymakers, caregivers, and patients to discuss the latest developments in digestive disease policy. The webinar included an overview of DDNC funding priorities, presentations from DDNC member organizations, and an informational session on the Safe Step Act.
The Safe Step Act
is a bill which would regulate the utilization-management technique known as “step therapy”- where patients are required by insurers or pharmacy benefit managers to deny patients access to the medicines selected by their physicians, until they have failed one or more lower-cost treatments. Alaska Senator Lisa Murkowski, lead sponsor of the bill, presented.
A major topic of discussion at the five-day conference was a recent paper
on step therapy entitled “Variation In Use And Content Of Prescription Drug Step Therapy Protocols, Within And Across Health Plans”. From the paper’s abstract:
Insurers limit the use of certain prescription drugs by requiring step therapy—that is, by allowing access only after alternatives have been tried and have failed. Using data from seventeen of the largest US commercial health plans, we examined step therapy protocols that determined patients’ eligibility for specialty drugs and identified ten diseases that are often subject to that requirement.
The authors’ analysis found that that 55.6 percent of step therapy protocols were more stringent than the corresponding clinical guidelines, and that these protocols varied widely both within and between. The authors observed that:
“These findings raise questions about potentially overly restrictive step therapy protocols, as well as concerns that variability across health plans makes protocols onerous for patients and practitioners alike. The findings thus suggest the need for state and federal legislation.”