Pennsylvania recently took steps to decrease a barrier that many cancer patients face in receiving effective, affordable treatment.
With Gov. Wolf’s signature on SB 225 reforming step therapy practices, Pennsylvania has secured a victory, ensuring patients gain quicker access to potentially life-saving medications prescribed by their physician.
A Pennsylvania native, Donald was just seven years old when he was diagnosed with acute myeloid leukemia. The good news is that his treatment plan, which included full body radiation, cured his cancer but left him with lifelong complications, including a thyroid that stopped functioning. Thankfully, Donald was subsequently administered an effective medication to manage his condition.
Unfortunately, Donald is not the only patient who has faced this situation. According to a 2019 ACS CAN survey, 1 in 3 cancer patients and more than half of physicians reported having to wait for an insurance plan to approve a cancer treatment, test or prescription drug because of utilization management policies resulting in delayed patient care.
The new law does not eliminate prior authorization or step therapy practices but, rather, requires health plans to adhere to independent clinical guidelines when setting any step-therapy protocols and maintain a time-sensitive exceptions process for patients and providers to use should they feel step therapy would harm the patient’s health.
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