Lawmakers are pushing measures that would enable patients to obtain medicine that their insurers wouldn’t normally cover unless they tried cheaper drugs first and were unsuccessful (Source: “Ohio bills would make it easier for patients to get more costly meds,” Cleveland Plain Dealer, Nov. 13, 2018).
With only weeks left before the General Assembly session ends, the bipartisan sponsors of Senate Bill 56 and House Bill 72 -- which are identical -- hope that one of the bills prevails. Sixty patient and physician groups back the effort to regulate what managed care organizations call “step therapy,” since patients begin with the most cost-effective and widely proven drug and progress to more expensive and riskier drugs only when the cheaper ones are unsuccessful.
Health insurers, however, oppose the legislation. They note patients are grouped together in insurance pools, and the costs of the more expensive drugs will be passed on to everyone if the legislation passes. Prescriptions currently account for 23 cents of each dollar people pay on their premiums. Ohio Medicaid has cautioned the legislation could cost the state tens of millions of dollars a year.
“The insurance plans have been the primary and virtually sole opponent,” said sponsor Sen. Peggy Lehner, a Dayton-area Republican. “Medicaid hasn’t taken a position against it but they have expressed concerns. One of those are the costs that might be incurred."
However, 18 states have already passed similar “patient protection laws” on step therapy and none have reported major price hikes, Lehner said.