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Federal Step Therapy Legislation Introduced
By Miriam Goldstein, Staff
On April 6, 2017, Congressmen Brad Wenstrup (R-Ohio) factor products are biological products and are not therapeu-
and Raul Ruiz (D-California) introduced HR 2077, the tically equivalent or interchangeable. A “one size fits all” ap-
“Restoring the Patient’s Voice Act of 2017.” HR 2077 addresses proach doesn’t work in hemophilia care. Also, importantly,
the practice of step therapy, which is a tactic some insurers there is no clear clinical definition of what treatment “failure”
take to limit prescription drug costs by restricting patient ac- means for a bleeding disorders patient and as a result, there
cess to expensive medicines. In May, HFA held our 4th annual are no clear endpoints for step therapy experiments. Yet, as we
Patient Fly-In in which we advocated for the bill’s passage and in the community know, the potential consequences of inad-
recognized Rep. Wenstrup’s sponsorship at our Congressional equate treatment (whether a major bleed, or cumulative dam-
Reception. Here’s why HR 2077 is important to our community. age from repeated bleeding episodes) are unacceptably high.
When an insurance company implements step therapy, it For all these reasons, HFA has consistently opposed any at-
requires patients to try and fail on an approved drug before tempt to apply step therapy in the context of bleeding disor-
allowing them to get access to the non-listed medicine that ders treatment. In addition to engaging with insurers directly
There is a need for federal legislation because state step therapy
laws do not apply to self-funded insurance plans…
their doctors believe will be the best treatment for them. on this issue, HFA and other patient groups have advocated
Sometimes a patient has already tried the approved for the passage of state laws restricting the use of step therapy.
drug and knows that it won’t be effective for them, yet Fifteen states have adopted step therapy legislation to date,
the patient is still forced to repeat the unsuccessful effort but because of the complexities of federal insurance law, these
to treat with that medicine. state step therapy laws do not apply to self-funded insurance
plans, a category that includes most health coverage offered by
Fortunately, step therapy is not yet common for large employers.
thosewithbleedingdisordersbutitsincreased
use in other health contexts suggests in-
surers may follow suit with respect
to bleeding disorder treatments.
HFA strongly maintains
that step therapy is al-
ways inappropriate in
the context of hemo-
philia care. Clotting
HFA CEO & President, Kimberly Haugstad, MBA; Congressman
Brad Wenstrup; and HFA Director of Policy and Government Rela-
tions, Katie Verb, JD, pose for a photo at the HFA Congressional
Reception, May 24, 2017. Wenstrup was recognized for introducing
a bill that would prevent insurers from restricting patient access to
medicines to limit costs.
6 Dateline Federation | Fall 2017
