Recently, the Arthritis Foundation lead the charge in the passage of three new laws in the state of California that will ensure patient care and continue to keep prescription costs low. The laws focused on issues dealing with Biosimilar Substitution, Step Therapy, and controlling out-of-pocket costs for residents of California.
With specific regard to the new legislation regulating the step therapy process, Krystin Herr, vice president of government affairs and advocacy in the pacific region for the Arthritis Foundation, stated, “Many patients with complex chronic conditions, such as rheumatoid arthritis, do not always fit a ‘one size fits all’ approach to medication. However, step therapy protocols do not reflect that.”
Here is a breakdown of the 3 new laws and how they affect people with arthritis in California:
Legislation has been signed into law that will allow the use of certain biosimilar medications that may be less expensive than biologics. Access to innovative medications is expected to bring more treatment options to people with arthritis.
The law also contains an important provision that requires a pharmacist to notify a patient of the substitution of a biosimilar for a biologic and the prescriber within 5 days of dispensing the medication.
The process of requiring people to try and fail certain medications before having access to their prescriber’s preferred medication has been limited for people in California. The new law will help people with arthritis to more quickly access the medication that is appropriate to their needs based on the determination of their prescriber.
Under the law, prescribers will partner with prior authorization system to have step therapy requests processed thereby reducing paperwork delays. The electronic processing systems will give insurers 72 hours (or 24 hours for urgent cases) to review/deny step therapy requests or they are deemed approved. In situations where insurers deny override requests they must identify the basis for the denial and if inadequate information is the reason for the denial, they must specifically identify the information that is missing.
The out of pocket cost obligation of co-pay or co-insurance for a 30-day supply of an individual prescription drug in California will be capped at $250 (or $500 for bronze-level health insurance plans). This is a direct benefit to the bottom-line of people, caregivers and families dealing with access to important and life changing arthritis medications.
The Arthritis Foundation continues to have one of the strongest voices at the state and federal level as the authority on arthritis and related diseases. The passage of these three laws in California is just another example of the Foundation advocating for people living with arthritis as the Champion of Yes.