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!
Sponsored by Delegate John Kelly who personally experienced the effects of step therapy, House Bill 4040 (HB 4040) establishes a clear channel for patients and practitioners to request an override when an insurance provider levies such mandates. With override approval, patients can take medications, as prescribed by their physicians, without enduring a long and arduous process of trying other medications that might prove ineffective or dangerous, all while the pain and disability of their arthritis escalates.
“Passing HB 4040 is great news for West Virginians,” said Kirsten Smith who is on the Arthritis Foundation’s Board of Directors. “As a patient, this means I won’t have to step through different therapies that are defined by insurers who don’t know me or the best way to care for my disease. My health care providers will decide the best treatment for my specific condition. I’ll have a more direct path to pain relief and a better quality of life.”
Our success with HB 4040 would not have been possible without involvement and support from our West Virginia Advocates and coalition groups including the West Virginia State Rheumatology Society, West Virginia Medical Society and Parkinson’s Support Groups.
While we have achieved this great success in West Virginia, step therapy strategies are active in many states throughout the country. Our work is not done and we need your help to continue the fight. Learn more about our powerful Advocacy program.