Tag Archives: step therapy

Iowa State Capitol

Victory in Iowa! Governor Branstad Signs into Law a Bill to Curb Step Therapy!

The Iowa arthritis community is celebrating Governor Branstad signing into law House File 233 on May 10, 2017.

The bill, unanimously passed by both chambers, puts limits on an insurance industry protocol known as step therapy which requires patients to try and fail medications identified by the insurance company before agreeing to cover medications prescribed by the treating physician. The bill will increase access to care for arthritis patients by limiting step therapy practices in Iowa.
Continue reading Victory in Iowa! Governor Branstad Signs into Law a Bill to Curb Step Therapy!

West Virginia Step Therapy

Step Therapy Win in West Virginia!

Step therapy is a cost saving tactic used by insurers that requires people with arthritis and other potentially debilitating conditions to try and fail lower-cost medications before covering more expensive treatments. In other words, insurance companies oftentimes disregard treating physicians’ knowledge of their patients and related expertise, forcing patients to try cheaper medications, all to save a few dollars.
Continue reading Step Therapy Win in West Virginia!

New York Arthritis Biosimilars

New York Step Therapy Reform Legislation Signed into Law by Governor Cuomo

As we ring in the new year, we celebrate a major step therapy legislative win in New York! An increasing number of health insurers around the country are utilizing fail first or step therapy practices that require patients to try and fail one or more formulary medications before providing coverage for the originally prescribed non-formulary medication. Rather than taking into account the needs of the individual patient, insurers are determining drug sequences based on cost. These practices can vary wildly insurer to insurer with no consistency on how to establish or apply these fail first protocols.
Continue reading New York Step Therapy Reform Legislation Signed into Law by Governor Cuomo

Arthritis Step Therapy Illinois

Victory in Illinois! Bill to Curb Step Therapy Signed into Law by Governor Bruce Rauner!

Imagine going to your healthcare provider and being told that your medication is no longer covered by your insurance. Kim and Gary Kitowski, of Columbia, IL, have faced that reality more than once. Kim, an Arthritis Foundation Ambassador, has lived with arthritis for more than 30 years and her husband, Gary, was diagnosed with multiple sclerosis eight years ago. Because of step therapy, both have fought for access to medications that were prescribed by their doctors.
Continue reading Victory in Illinois! Bill to Curb Step Therapy Signed into Law by Governor Bruce Rauner!

Arthritis Foundation State Advocacy

Arthritis Foundation Collaborates with Providers at the State Level to Advocate for the Arthritis Community

Our advocacy team is incredibly active at the state level, leading the way to make sure that arthritis patients have access to critical medications. Our volunteer Advocates make a significant impact and help achieve tangible results by sharing their stories and asking elected officials to support legislation that is important to them and their families. But beyond fighting for key legislative changes and being vocal in raising awareness and sharing stories that help put faces with arthritis, we also make strides for the arthritis community when we link the voices of patient with the provider community – as we have done recently and successfully in New York and Ohio.
Continue reading Arthritis Foundation Collaborates with Providers at the State Level to Advocate for the Arthritis Community

Missouri Advocacy Step Therapy Arthritis

Step Therapy Bill Makes Huge Progress in Missouri Legislature with Help of Young Advocates

Update as of June, 2016: A huge victory has occurred in Missouri! House Bill 2029 has been signed by Governor Jay Nixon – thanks to the efforts of our amazing advocates! We are thrilled that Governor Nixon has signed HB 2029 into law. The Arthritis Foundation would like to thank all of the advocates who contacted their legislators and Governor Nixon. Continue reading Step Therapy Bill Makes Huge Progress in Missouri Legislature with Help of Young Advocates

Advocacy Kentucky Biosimilars Step Therapy

Advocates in Kentucky Get a Big Win for Biosimilar Substitution

Big news for our arthritis community in Kentucky! On April 13, 2016, Gov. Matt Bevin (R – KY) signed Senate Bill 134 into law. The law creates a pathway for the introduction and use of biosimilars into the mainstream marketplace. Biosimilar medications have the potential to provide safe and effective treatment to people with arthritis at a potentially lower cost than name-brand biologic medications.

The many letters, calls and visits made by Arthritis Foundation Advocates in Kentucky played a significant role in the passage of SB 134.
Continue reading Advocates in Kentucky Get a Big Win for Biosimilar Substitution

West Virginia House Bill 4040 Step Therapy

West Virginia Advocates Make Strides Against Step Therapy!

West Virginia residents who are living with arthritis have good reason to celebrate. On March 29, 2016, Governor Earl Ray Tomblin signed into law a bill that addresses a growing and concerning insurance industry practice. Commonly known as “step therapy” or “fail first,” some insurance providers began refusing to cover physician prescribed medications, instead insisting that patients first try other less expensive treatments – all to save a buck!
Continue reading West Virginia Advocates Make Strides Against Step Therapy!

Step Therapy Arthritis Indiana

Victory in Indiana – Fighting Step Therapy

For people like Renda Brower, the fight against arthritis and barriers to treatment is an everyday battle. Renda’s husband and two of her children have ankylosing spondylitis. The process to get the medication they need inspired Renda to become an Advocate and to share her story in support of Indiana step therapy bill, Senate Bill 41 (SB41). Today, we celebrate a big victory for the Browers and the 1.3 million people (6,400 of whom are children) in Indiana living with arthritis.

Today, Governor Pence signed into law SB41, putting limits on an insurance industry protocol, known as “step therapy” or “fail first,” which require patients to try and fail medications the insurance provider recommends before they will cover medications as prescribed by their physician. This practice has become pervasive in the insurance industry, even when the prescribed drug is deemed more medically appropriate by the patient’s physician.
Continue reading Victory in Indiana – Fighting Step Therapy

Local Arthritis Advocacy & Access Priorities

Arthritis Foundation & Advocates Work State-By-State to Ensure Access to Care

Health care laws and policies are keys to whether millions of Americans with arthritis get the care they need to manage their disease and live their lives to the fullest. For some, it can mean the difference between walking and a wheelchair, employment and disability, even life and death.

And although the U.S. Congress is at an impasse, states’ legislatures are taking action to protect and promote access to care and medications – including those for people with arthritis.

“With the gridlock in Congress, it could take years for federal legislation to move on many of the issues related to access to medications and care,” says Mark Guimond, director of state legislative affairs for the Arthritis Foundation. “States are not waiting. Some states can consider and enact a new law in just a few short months.”

So why does state legislation carry so much weight? For starters, most of the specifics of health insurance plans are governed by state law, so the laws in your state directly affect your access to care. For example, state laws define out-of-pocket drug costs and whether insurance covers an adequate network of health care facilities and doctors.

That is why the Arthritis Foundation and its volunteer advocates regularly work with state legislators and policy makers. The Foundation helps identify challenges, and volunteers share first-hand experiences. Together, they create a compelling lobby for the 52 million adults and 300,000 children in the U.S. with doctor-diagnosed arthritis.

“Using our motivated volunteer advocates to serve as citizen lobbyists is giving us the power to enact laws in state after state that limit the out-of-pocket costs on medications, reduce wait times for insurers to authorize specialty medications and many other benefits,” says Guimond.

Our Key Advocacy Priorities

Following are key issues the Foundation is fighting for at the state level to help people with arthritis afford medications and get the treatments they need.
Continue reading Arthritis Foundation & Advocates Work State-By-State to Ensure Access to Care