MADISON – Today, Representative Lisa Subeck (D-Madison) and Senator Janis Ringhand (D-Evansville) introduced LRB-4266, which would ensure metastatic cancer patients have access to the most current and appropriate treatments by exempting metastatic cancer treatments from step-therapy protocols. The bill builds upon the bipartisan 2019 Act 12, which created exceptions to step-therapy protocols, establishing regulations that insurance companies must follow when requiring a patient to try a different treatment than the one prescribed by the patient’s physician and limiting the practice to ensure patient access to the most appropriate care. Further legislation is needed to include metastatic cancer treatments under the law passed in 2019.
To save money, insurers often impose a “fail-first” step therapy requirement before allowing patients to try a new drug or treatment prescribed by their physician. This practice means patients must try cheaper or alternate treatment methods an insurer is willing to pay for the most advanced treatments available.
“A cancer patient’s primary focus should be for the best possible care, treatment, and outcomes,” said Sen. Ringhand. “Making patients adhere to ‘fail first’ step therapy practices instead of what would contribute to a better quality of life is a cruel and potentially life-shortening requirement for someone battling metastatic cancer.”
Metastatic cancer, sometimes referred to as Stage IV cancer has initially developed in one organ and subsequently spread to other locations in the body, such as the bones, brain, and liver. Often metastatic cancers, such as metastatic breast cancer, have no cure, but access to appropriate treatment can be vital to extending a patient’s life and maintaining their quality of life.
“When a patient is facing a metastatic cancer diagnosis, they cannot afford to waste precious time with a trial and error approach dictated by insurance companies and pharmacy benefit managers,” said Rep. Subeck. “Every patient facing a devastating metastatic cancer diagnosis deserves access to the most current and appropriate treatments as determined by their physicians, not their insurance companies.”
Nine other states, including Colorado, Connecticut, Delaware, Georgia, Illinois, Maryland, North Dakota, Ohio, and Pennsylvania, have passed similar legislation eliminating step therapy protocols for primary treatments for metastatic patients. Rep. Subeck and Sen. Ringhand worked in partnership with Susan G. Komen® in the development of this legislation. October is Breast Cancer Awareness Month.