Among the hundreds of bills passed last week, the State Legislature sought to curb the practice by health insurance companies of forcing people to try lower-cost drugs first. This could mean an end to frustrating trial and error for patients suffering from chronic conditions such as multiple sclerosis, psoriasis, rheumatoid arthritis, mental illness and cancer.
Gov. Andrew M. Cuomo should sign the bill into law.
Known as step therapy, the practice of requiring people to take lower-cost — and potentially less effective — medicines is a way for insurance companies to keep a lid on spending. Slowing the growth of health care costs is crucial, but there are some individuals for whom generic drugs aren’t as effective. One 33-year-old Brooklyn resident told legislators that a 3-year struggle to get the proper medication for psoriatic arthritis cost her two jobs and weakened her immune system. This is not acceptable.
New York’s bill doesn’t ban the use of step therapy protocols by insurers, but it gives doctors and patients an easier path to appeal insurance company decisions. Insurers must respond to an appeal within three days, or within 24 hours in life-threatening cases. If an insurance company doesn’t respond within the time frames, the appeal is deemed granted in favor of the patient.
Seven other states have passed laws to prohibit or limit step therapy, and similar bills are under consideration in a few more. Kansas, however, has taken the opposite action, requiring doctors to try cheaper drugs first for Medicaid recipients to lower soaring costs. That’s another way to force drug companies that spend fortunes trying to brand their drugs or entice doctors to prescribe them to respond to the market and rein in costs. In the process, however, a patient’s health should not be jeopardized in favor of cost savings. — The editorial board