On March 5, the South Dakota House of Representatives voted for legislation to ensure better access to treatments for patients across the state by putting new parameters around an insurance industry practice known as “step therapy.”
Currently, under step therapy, patients may be forced to try one or more medications other than what their health care provider ordered before they are given access to originally prescribed medication. Such delays in care can lead to serious health outcomes for patients, particularly for patients with complicated or chronic health conditions.
Senate Bill 155 passed on a 66-0 House vote. Passed by the Senate on a 35-0 vote last week, the bill will now head to Governor Kristi Noem’s desk for her signature.
SB 155 was sponsored by Senator Kris Langer (R-District 25) and Representative Michael Diedrich (R-District 34).
This legislation saw a collective effort of patient advocates, provider groups, insurers and lawmakers, in an effort to ensure timely access to the medications health care providers prescribe.
“Today is a big win for patients across South Dakota, “ said Brian Henderson, State Policy Manager for the Coalition of State Rheumatology Organizations. “Because of the leadership of Senator Langer and Representative Diedrich, patients and doctors now have a better process under which they can work to get patients the medications needed to effectively treat their disease.”
When signed into law, patients and physicians will have a more accessible appeals process. Insurers will be required to respond to appeals within 72 hours for emergencies and five calendar days for non-emergencies. In addition, if a patient can demonstrate that the preferred step therapy drug may be harmful or ineffective in their case, they will be exempt from taking that medication.
“Patients with complicated medical conditions often find themselves stuck waiting for treatments to be approved, while having to try other medications that their doctors know will not be as effective,” said Kristen Stiffler, state government relations manager, National Psoriasis Foundation. .“This legislation doesn’t seek to ban step therapy, but to provide patients and doctors a process to ensure the best course of treatment is provided in a timely manner.”
SB 155 mirrors legislation that has been passed in more than two dozen other states.