Today the Pennsylvania Society of Oncology and Hematology (PSOH) and the American Society of Clinical Oncology (ASCO) came out in strong support of HB 1194, proposed legislation to promote transparency in prior authorization and step therapy policies, which would put in place important safeguards to ensure that patients get the care they need.
At an event at the State Capitol Building, Pennsylvania State Representative Steve Mentzer was joined by patients and medical professionals to voice support for the bill that he plans to introduce this fall. PSOH and ASCO applauded Rep. Mentzer for his leadership and urged Pennsylvania lawmakers to pass this legislation as soon as possible.
"We strongly endorse HB 1194, which takes a big step forward to make sure that people with cancer in Pennsylvania can get timely access to high-quality, appropriate cancer care," said PSOH President Usman Shah, MD. "Patients with cancer should never have to 'fail first' before getting access to the evidence-based care recommended by their oncologist."
Payer-imposed "utilization management" policies like prior authorization and step therapy are becoming more common in cancer care as payers search for ways to control the rising cost of care. The proposed bill aims to specifically address step therapy or "fail first" policies, which require patients to try and fail to have a desired clinical outcome on a lower cost medication before they can access the medication prescribed by their health care provider. This not only delays patient access to proper treatments, it potentially leads to irreversible disease progression and other significant health risks. The potential bill would establish a framework for when it is medically appropriate to exempt a patient from step therapy.
The proposed bill would also put in place safeguards to improve the prior authorization process, another payer-imposed policy requiring patients or prescribers to secure pre-approval for a prescribed treatment, which can lead to delays in cancer care delivery. A survey from the American Cancer Society Cancer Action Network (ACS CAN) found one in three of patients and caregivers surveyed reported delays in cancer care because their physician was waiting for health plan approval. The bill would promote more efficient electronic prior authorizations and set deadlines for payers to respond to prior authorization requests.
"People with cancer continue to face delays in care due to harmful utilization management tactics, like prior authorization and step therapy protocols," said ASCO President Howard A. "Skip" Burris III, MD, FACP, FASCO. "These treatment delays can lead to serious complications and irreversible disease progression. This bill puts in place important safeguards so that patients with cancer have access to the treatment they need, when they need it. ASCO will continue to oppose any utilization management policies that restrict patient access to high-quality cancer care and will work with stakeholders to develop and implement policies that better serve our patients."
Federal legislation to address prior authorization and step therapy policies has been introduced in the U.S. House of Representatives and the U.S. Senate. In late September, representatives from ASCO and PSOH met directly with Members of Congress to urge them to move quickly to pass legislation to establish guardrails to streamline and improve prior authorization and step therapy policies.