The Wisconsin Step Therapy Coalition, a statewide organization representing individuals with chronic diseases and health care providers, this week announced their support for newly introduced legislation aimed at providing patient protections and guardrails on an insurance industry practice known as step therapy.
The coalition says step therapy often impacts those with chronic diseases the most, imposing delays that keep patients from receiving doctor prescribed medications.
“In Wisconsin, the practice of step therapy is delaying access to effective medications that providers know will work,” said Angie Thies, state government relations manager for the National Psoriasis Foundation and coalition leader.
“Step therapy is being utilized as a tool to force patients to complete time-consuming ‘steps’ that involve trying-and-failing at multiple drugs, when in most cases the provider knows what will work for the patient from the outset," Thies added.
Required ‘steps’ can take weeks or months, sometimes years for individuals to complete before their insurer will cover the prescription.
"The practice of step therapy is especially cruel to individuals facing chronic, progressive conditions like multiple sclerosis or diabetes," Thies said. "Delays in getting the right treatment can make all the difference when you are talking about functionality – it really is the difference between walking with a cane and being wheelchair bound for the rest of your life."
The legislation proposed by Rep. John Nygren, Rep. Loren Oldenburg, Sen. Alberta Darling and Sen. André Jacque doesn’t ban the practice of step therapy, but instead, puts common sense guardrails in place ensuring that patients and providers can get access to the right medication at the right time for the patient, Thies said.
Senate Bill 26 (SB26) and Assembly Bill 24 (AB24) have received bipartisan support and create appropriate exceptions to return prescription decision-making back to health care providers and their patients, according to the coalition.
“Doctors who treat chronic diseases in Wisconsin are very familiar with the requirements for step therapy. In certain cases, it can require patients to fail medications that are either contraindicated or unlikely to work. This can make things significantly worse for patients with debilitating conditions,” said Dr. Lisa Arkin, a pediatric dermatologist in Madison.
“Step therapy often ‘steps’ on these individuals, creating unnecessary delays and impeding access to the proper medications we know will work in addressing their illness," Arkin added.
Forcing patients to fail-first on medications that physicians know will not work, or those which actually may worsen the disease process in certain cases, can result in trips to the emergency room, patients getting sicker and additional medical costs, according to Arkin.
"It’s time to restore our voice and our patients," Arkin said, "in the step therapy process and this legislation will do that.”
The Wisconsin Step Therapy Coalition praised chief authors of the legislation Rep. John Nygren (R – Marinette), Rep. Loren Oldenburg (R – Viroqua), Sen. Alberta Darling (R – River Hills) and Sen. André Jacque (R – De Pere) for supporting those with chronic illnesses and health care providers around the state.
Additional cosponsors of the bills offering their bipartisan support in the State Senate and State Assembly include: Sen. Roger Roth (R – Appleton); Sen. LaTonya Johnson (D – Milwaukee); Sen. Dan Feyen (R – Fond du Lac); Sen. Howard Marklein (R – Spring Green); Sen. Stephen Nass (R – Whitewater); Sen. Luther Olsen (R – Ripon); Sen. Janis Ringhand (D – Evansville); Sen. Van Wanggaard (R – Racine); Sen. Patrick Testin (R – Stevens Point); Sen. Robert Cowles (R – Green Bay);
Sen. Devin LeMahieu (R – Oostburg); Sen. Tim Carpenter (D – Milwaukee); Sen. Robert Wirch (D – Kenosha); Rep. Michael Schraa (R – Oshkosh); Rep. Debra Kolste (D – Janesville); Rep. Lisa Subeck (D – Madison); Rep. Jessie Rodriguez (R – Oak Creek); Rep. Joan Ballweg (R – Markesan); Rep. Barbara Dittrich (R – Oconomowoc);
Rep. Kevin Petersen (R – Waupaca); Rep. Cody Horlacher (R – Mukwonago); Rep. Tyler Vorpagel (R – Plymouth); Rep. Jeffrey Mursau (R – Crivitz); Rep. Mike Kuglitsch (R – New Berlin); Rep. John Spiros (R – Marshfield); Rep. James Edming (R – Glen Flora); Rep. Rick Gundrum (R – Slinger); Rep. Mary Felzkowski (R – Irma); Rep. Bob Kulp (R – Stratford); Rep. Ken Skowronski (R – Franklin); Rep. Jeremy Thiesfeldt (R – Fond du Lac);
Rep. Robert Brooks (R – Saukville); Rep. Timothy Ramthun (R – Campbellsport); Rep. Paul Tittl (R – Manitowoc); Rep. Rob Swearingen (R – Rhinelander); Rep. Todd Novak (R – Dodgeville); Rep. John Jagler (R – Watertown); Rep. Nancy VanderMeer (R – Tomah); Rep. Shannon Zimmerman (R – River Falls);
Rep. Scott Krug (R – Nekoosa); Rep. Romaine Quinn (R – Barron); Rep. Mike Rohrkaste (R – Neenah); Rep. Cindi Duchow (R – Town of Delafield); Rep. Gae Magnafici (R – Dresser); Rep. Mark Born (R – Beaver Dam); Rep. Tony Kurtz (R – Wonewoc);
Rep. Janel Brandtjen (R – Menomonee Falls); Rep. Jon Plumer (R – Town of Lodi); Rep. Rob Summerfield (R – Bloomer); Rep. Amy Loudenbeck (R – Clinton); Rep. Jim Ott (R – Mequon); and Rep. Daniel Knodl (R – Germantown).
“Getting doctor prescribed medications for an illness, especially for those with chronic diseases, should not be a confusing process,” said Nygren. “The step therapy bill enhances the doctor patient relationship and will expedite appropriate access to lifesaving medication for patients across Wisconsin.”
“Patient health is a top priority in Wisconsin and passing a law that places appropriate exceptions on the step therapy process is needed,” said Darling. “There are clear circumstances when step therapy protocols need to be overridden, and this bill puts those circumstances into Wisconsin law. This bill will help patients get the care they need without unnecessary obstacles or delays.”
Similar legislation has become law in 21 states including Minnesota and Iowa, according to the coalition. A step therapy law will ensure appropriate, common sense guardrails are applied to the policy to help patients receive the most effective treatments as quickly as possible.
Wisconsin legislation would not ban step therapy, but instead offer a clear path to appeal the process and provide certain circumstances when an individual and health care provider could override a health plans’ step therapy protocol when medically necessary.
SB26 and AB24 will not limit the number of steps an insurer can impose, nor will they prioritize the prescribing of brand name drugs over generics.
Members of the Wisconsin Step Therapy Coalition include: Allergy & Asthma Network; Alliance for Patient Access; American Cancer Society Cancer Action Network WI; American Academy of Dermatology Association; American Diabetes Association; American College of Rheumatology; American Lung Association in Wisconsin; Arthritis Foundation;
Coalition of State Rheumatology Organizations; Crohn’s & Colitis Foundation; Epilepsy Foundation; Global Healthy Living Foundation; Hometown Pharmacy; International Cancer Advocacy Network; International Pain Foundation; Mental Health America of Wisconsin;
Multiple Sclerosis Association of America; National Alliance on Mental Illness Wisconsin; National Infusion Center Association; National Multiple Sclerosis Society; National Organization for Rare Disorders; National Psoriasis Foundation; The Leukemia and Lymphoma Society; US Pain Foundation; Wisconsin Academy of Family Physicians; Coalition of Wisconsin Aging and Health Groups; Wisconsin Primary Health Care Association; and the Wisconsin Rheumatology Association.