Texas Step Therapy Win

Victory in Texas – Legislation Limits Step Therapy

Exciting news in Texas! On May 23, Governor Greg Abbott signed Senate Bill 680 into law, limiting the use of step therapy. Texas now joins a growing number of states that have enacted laws that regulate the use of step therapy. With over 4 million adults and 24,900 kids with doctor-diagnosed arthritis in Texas, this is a major victory!

Step therapy is used by health insurance providers to control the order and use of prescriptions drugs. A patient could be required to try and fail lower-cost or other drugs selected by their insurance provider before coverage is granted for the drug prescribed by the patient’s treating physician. For patients, this barrier to care prevents timely access to doctor prescribed treatments and can be the difference between full mobility and joint damage.

What does the passage of this bill mean for people with arthritis?

The bill includes essential patient protections to improve the safety and efficiency of step therapy protocols.  This includes a requirement that insurers must consider using science and evidence-based clinical practice guidelines to develop step therapy protocols, rather than relying exclusively on cost data. The bill also requires a clear and expedient process that can be used by treating physicians to request an override of a step therapy protocol.

We would like to thank Governor Abbott for signing SB 680 into law, Senator Kelly Hancock and Representative Greg Bannon for championing the bill through the legislative process, and our Texas Advocates for their tireless work on getting the bill passed this year.

Angela McComb, one of the Arthritis Foundation’s Ambassadors, shared her experience with step therapy in an op-ed that ran in the Austin American Statesman. Both of her children (who each have juvenile arthritis) were forced to fail the insurance-recommended alternative before receiving coverage for the medication they were originally prescribed. This delay caused more pain and less medical stability for her children. “I don’t want my experience to happen to others – I am thrilled to hear that Governor Abbott signed SB 680 into law. Thank you,” said McComb.

While we have achieved this great success in Texas, we still have a long way to go in states throughout the country. Our work is not done and we need your help to continue the fight. Learn more about our advocate program!

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One thought on “Victory in Texas – Legislation Limits Step Therapy

  1. I am glad I found out about this bill. I am going through this right now. I had to do the step therapy in 2015 to get my brand blood pressure medication covered. I almost ended up in the ER because my blood pressure went up from taking the generic of the drug. after 3 generics the insurance finally approved my brand. Now that the same insurance that I got approved from, switched to another drug insurance co only(medical still the same insurance) they want me to go through this again. The new carrier will not take the approval and transfer it from the old carrier and my Dr is having to send all the information to the new one for approval this is causing me a lot of stress and i am about to have to go pay the full amount for my brand medicine today. I am not sure why they cant use the approval from the insurance when I went through this in 2015?

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