Legislation to Regulate ‘Step Therapy’ Unanimously Passes House

OKLAHOMA CITY – A consumer protection bill that seeks to limit the insurance practice known as ‘step therapy’ passed off the House floor today with a vote of 94 to 0.

House Bill 2638, authored by Rep. Cyndi Munson (D-85, Oklahoma City), requires that health plans beginning in 2020 adopt guidelines governing step therapy.

Step therapy, also known Fail First, is an insurance policy protocol that requires the cheapest drug to be prescribed to a patient first, rather than the medicine the doctor originally prescribed.

According to the advocacy website Fail First Hurts, “When a patient has to fail first on a drug before being allowed to take the medication originally prescribed, the patient, physician and public health suffer. By limiting the medication options, both doctors and patients are forced to compromise their treatment decisions in a way that is dangerous, time consuming and more expensive in the long-term.”

The guidelines which House Bill 2638 seeks to install would include criteria relating to the procedure determining medical necessity for step therapy. Those guidelines would need to be endorsed by a panel of unbiased experts (or peer-reviewed publications), research-based, and created through a transparent process. The measure further requires that for any prescription-drug coverage restriction under a health plan, the insurer must provide an accessible process to request a step therapy exemption.

“One of our jobs as lawmakers is to step in and advocate for our constituents when they are being treated unfairly,” Munson said. “By regulating and limiting step therapy, we are ensuring that Oklahomans get the medicine and healthcare service they need. I appreciate my colleagues for working on this issue, and I can’t wait to see it on the Governor’s desk.”

This legislation was supported by a large coalition of healthcare providers, businesses and nonprofits.

“Navigating a chronic illness puts a heavy burden on Oklahoma families,” said Jenniafer Walters, Executive Director of the Epilepsy Foundation of Oklahoma. “Step therapy reform will make that burden a little lighter. We are grateful to the House for passing this vital legislation that puts important guardrails on a process that too often puts insurance companies in between health care providers and their patients.”

HB2638, which had 21 Representatives sign on as co-authors, now moves across to the Senate where its progress will be supervised by Senator Dave Rader (R-39, Tulsa) the principal Senate co-author.