N.Y. Patients, Providers, Lawmakers To Governor Cuomo:Take Final "Step" To Protect Patient Health

ALBANY, N.Y. - Nov. 22, 2016 - PRLog -- Patients, advocates, health care providers and state legislators from across New York are calling on Governor Andrew Cuomo to sign legislation that will put in place protections for patients and ensure that doctors have the final say in their treatment plans as soon as it arrives on his desk.   When signed, S.3419C/A.2834D will put parameters around the insurance industry requirement known as "step therapy" or "fail first".   Legislation that offers protection to patients could be even more critical as proposed changes to the healthcare system in this country are debated in the coming months and supporters say action is warranted now more than ever.

Step therapy forces patients to try and fail on medications other than what their doctor has prescribed before an insurer will cover the cost of the originally recommended treatment.  When applied inappropriately, patient health can be negatively impacted due to the delay in receiving or not receiving critical care and the disease progression that may result.

S.3419C/A.2834D sponsored by Senator Catharine Young and Assemblyman Matthew Titone gives doctors a standardized, transparent process to seek exceptions from step therapy for patients needing a particular treatment, based on that individual's personal medical situation.  The legislation passed unanimously in both the New York Senate and the New York Assembly during the 2016 legislative session.  Now, nearly 80 patient and provider organizations and the legislative sponsors who advanced the bill are asking Governor Cuomo to take the final step and sign this pro-consumer legislation into law.

The bill does not ban step therapy or the number of steps an insurer can implement.  The bill requires insurers to respond to step therapy appeal requests within 72 hours and 24 hours in emergency situations to prevent unnecessary delays in critical care for patients. Also the bill includes standards or guardrails around exception processes to ensure that they are fair and workable for patients and their health care providers.

"We proposed and passed this important patient protection legislation because we heard from New Yorkers about how step therapy impacted their lives and their health," said Senator Young.  "Our colleagues responded with overwhelming support and now we need Governor Cuomo to join us to ensure New Yorkers have access to the medications they need to treat serious diseases and conditions."

"It is time for this legislation to be signed into law in New York," said Assemblyman Titone.  "Insurance companies are practicing medicine and decisions being made are exclusively based on cost, at the expense of patient health.  It's not often that our colleagues in Albany come together in such a non-partisan way to support a piece of legislation—but this bill makes sense and deserves Governor Cuomo's support as well. "
"Health care decisions should be based on good science, not on insurance company financial interests," said Assembly Health Committee Chair Richard N. Gottfried.  "Where step therapy is required, it should be based on legitimate clinical guidelines with strong patient and provider protections.  This bill is a valuable step toward protecting patients."

Step therapy can affect a wide range of medical conditions.  Cases of step therapy have been documented in patients of all ages.

"Support for this bill has been overwhelming across the state," said Julie Hart, American Cancer Society Cancer Action Network (ACS CAN) director of New York government relations. "In just the last several weeks, ACS CAN volunteers and staff have worked to gather thousands of signatures from New Yorkers who want this bill to become law.  We are grateful for the support that Governor Cuomo has shown cancer patients in New York. Treatment for cancer patients can be complex and we firmly believe the step therapy legislation will help ensure that all patients will receive the right treatment for their medical needs."

"I've witnessed the negative effects of step therapy on individuals struggling to manage serious, complex conditions and experienced it personally," said Kathleen Arntsen, President and CEO of the Lupus and Allied Diseases Association. "Insurance bureaucrats with limited medical knowledge should not have the power to make treatment decisions that have potentially life altering consequences for patients."

"Every New Yorker knows someone who has been impacted by a serious illness—whether it be cancer, HIV/AIDS, mental health issues or other chronic disease," said Shaina Smith, Director of State Advocacy & Alliance Development,  U.S. Pain Foundation.   "Imagine if your friend, spouse, parent, child, sibling was denied access to the medication their doctor said they need.  That's what step therapy does, and that's why the guardrails in this legislation are critical to ensure no one has to face an illness without proper care."

"With the number of questions surrounding the future of healthcare in this country, we must do everything we can to eliminate unnecessary barriers to patient access of prescription medications.   S.3419C/A.2834D establishes a fair, transparent process for patients, doctors and the insurance industry," said Jennifer Muthig, New York State Advocacy Director, National Multiple Sclerosis Society.

"While step therapy protocols are often medically appropriate, this legislation is necessary to address the circumstances where patients' health can be adversely impacted by an overly strict application of these protocols by health insurers" stated Dr. Malcolm Reid, President of the Medical Society of the State of New York.  "This legislation would give physicians a stronger ability to fight to assure their patients receive the most appropriate medications to treat their unique conditions.  We ask Governor Cuomo to sign this legislation into law"

"We've seen step therapy imposed much more aggressively and rigidly by insurers in recent years, blocking access to medications that patients need to treat or manage serious conditions," said Robert Ostrander, MD, President of the NYS Academy of Family Physicians.  "When patients don't get the treatment their personal physician knows is necessary, they suffer needlessly and their illness worsens.  It's time for Governor Cuomo to take the final step for patients and sign this legislation into law."

Step therapy use is increasing steadily. In 2010, nearly 60% of commercial insurers were using step therapy. In 2012, 54% of plans reported using for drug to treat cancer, up from 36% in the prior year.  While this legislation is not a ban on step therapy protocols, it implements needed patient protections and adds transparency to ensure they are used appropriately.

When signed, New York will join several other states who have put such patient protections in place, including Connecticut, Illinois, Indiana, Kentucky and Missouri.

A list of the nearly 80 organizations supporting S.3419C/A.2834D is below.

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Alliance for Patient Access
American Academy of Dermatology Association
American Academy of Pain Management
American Cancer Society (ACS)
American Autoimmune Related Diseases Association American Behcet's Disease Association
American College of Rheumatology
American Lung Association in New York
Arthritis Foundation
Association for Hispanic Mental Health Professionals Association of Black Cardiologists
Bleeding Disorders Advocacy Network
Center for Independence of the Disabled, NY
Crohn's & Colitis Foundation of America
Digestive Disease National Coalition
Epilepsy Association of Western New York
Epilepsy Foundation of Long lsland
Epilepsy Foundation of Metropolitan New York
Epilepsy Foundation of Northeastern New York
Epilepsy Foundation of Rochester/Syracuse/Binghamton
Epilepsy Society of Southern New York
Gay Men's Health Crisis (GMHC)
Global Healthy Living Foundation
Hepatitis Foundation lnternational
Hispanic Federation
Hispanic Health Network
Immune Deficiency Foundation
lnstitute for Community Living (ICL, lnc.)
lnternational Foundation for Autoimmune Arthritis International Institute for Human Empowerment
Latino Commission on AIDS
The Leukemia and Lymphoma Society (LLS)
Lupus Alliance of Long lsland/Queens
Lupus Alliance of Upstate New York
Lupus and Allied Diseases Association, Inc.
Lupus Foundation of Southern New York
Medical Society of the State of New York
Mental Health Association in New York State, Inc.
Mental Health Association of Columbia/Greene Counties
Mental Health Association of Franklin County
Mental Health Association of Niagara County
Mental Health Association in Ulster County
NAACP New York State Conference
National Alliance on Mental Illness - New York State
National Alliance on Mental Illness - Queens/Nassau
National Association of Hispanic Nurses - NY Chapter National Multiple Sclerosis Society - New York MS Coalition Action Network
National Psoriasis Foundation
New York Association on Independent Living
New York BIO
New York Chapter of the American College of Physicians (NYACP)
New Yorkers for Accessible Health Coverage
New York Oncology Hematology, P.C.
New York State Academy of Family Physicians
New York State Bleeding Disorders Coalition
New York State Osteopathic Medical Society
New York State Rare Disease Alliance
New York State Rheumatology Society
New York State Society of Dermatology and Dermatologic Surgery
Northeast Kidney Foundation Patient Services, lnc.
Roswell Park Cancer  lnstitute
Scleroderma  Foundation/Tri-State Inc.Chapter
Sisterlink Collaborative, Inc.
Sjbgren's Syndrome Foundation
Susan G. Komen Central New York Affiliate
Susan G. Komen Greater New York City Affiliate
Susan G. Komen Northeastern New York Affiliate
Susan G. Komen Twin Tiers Region Affiliate
Susan G. Komen Western New York Affiliate
U.S. Pain Foundation*
1in 9 The Long Island Breast Cancer Action Coalition