Ohio Passes Step Therapy Reform!

Yesterday, Governor John Kasich signed SB 265 into law, making Ohio the twentieth state to pass step therapy reform.  Effective January 1, 2020, the bill includes language which will reform how health plans apply step therapy requirements to patients needing certain medications. Ohioans for Step Therapy Reform, led by the SAIM Coalition member American Academy of Dermatology Association and consisting of over 60 groups including the Ohio Dermatological Association, Arthritis Foundation, Crohn’s & Colitis Foundation of America (including Central and Southwest Ohio), National Psoriasis Foundation, and the Ohio Academy of Family Physicians, pushed for step therapy reform for nearly three years.  Specifically, health care providers will have access to a convenient override procedure that will be granted if a patient’s health care provider demonstrated that:

• The required prescription drug in question is contraindicated for that specific patient, pursuant to the drug’s United States Food and Drug Administration (USFDA) prescribing information;
• The patient has tried the required prescription drug while under their current, or a previous, health benefit plan, or another USFDA approved AB-rated prescription drug, and such prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event;
• The patient is stable on a prescription drug selected by their health care provider for the medical condition under consideration, regardless of whether or not the drug was prescribed when the patient was covered under the current or a previous health benefit plan, or the patient has already gone through a step therapy protocol.

A health plan issuer must either grant or deny a step therapy exemption or appeal within ten calendar days of receiving a request, or, when related to urgent care services, within 48 hours. Any exemption request or appeal that is not replied to within this timeline is considered approved. When a health plan issuer grants a step therapy exemption, the issuer must authorize coverage for the prescription drug in question.