Change To Insurance Process Could Connect Cancer Patients To Treatment Faster

Dec 9, 2019

Ohio lawmakers are proposing a bill that would eliminate an insurance provision known as "step therapy" for people diagnosed with Stage IV cancer.

Step therapy is when an insurance company requires a patient to try a certain type of treatment before going with what a doctor has prescribed. The first treatment recommended by the insurance company tends to be a cheaper option compared to what could be a more expensive course of treatment from the doctor.

Critics call this the "fail first" system.

David Cohn, chief medical officer at the Ohio State University James Cancer Hospital, says step therapy can delay a patient from starting a more effective treatment.

"So it adds very important time on to a patient's schedule and it's that time that we're fighting against a patient with a stage four cancer doesn't always have that time," says Cohn.

A bill signed earlier this year, SB265, put more regulations on step therapy, which insurers opposed. 

Sen. Bob Hackett (R-London) says he's usually a supporter of step therapy and recognizes the value of it for other treatments. However, he says Stage IV cancer is a different circumstance where a patient needs what doctors see as the most effective treatment immediately.

"That's where I think it's real important because once again, Stage Four cancer, it's a really difficult situation for people to be in. And people do make it! And when you talk to people who make it, they'll say to you speed was everything," says Hackett.

Hackett says he had been working on this bill with his legislative aide Stephanie Kaylor who passed away earlier this month after a long battle with cancer.

Ohio Association of Health Plans president and CEO Miranda Motter put out a statement saying the association "looks forward to continued conversation with Senators Hackett and Craig, and we stand ready to review the language upon introduction. We look forward to understanding how the bill will enhance the comprehensive 'fail first' step therapy reform legislation recently passed by the Ohio General Assembly."

Hackett says insurance companies will still have the right to prior authorization before a patient's treatment is covered.