Lawmakers hear testimony on bill aimed at reducing step therapy

By  | 

AUGUSTA, Maine (WABI) - Lawmakers held a public hearing today on a bill dealing with step therapy.

There was testimony both for and against the bill, including from patients who are concerned about changing medications.

"So Hannah's 11," said Hannah's mother Peg Mitschele. "She has epilepsy. We're going to get up to talk today and testify in support of a bill so we don't have to live in fear of the insurance company telling us that we would have to change her medication. And it's really important to make sure that she doesn't have seizures."

Step therapy is a process used by insurance companies where they deny patients access to medication that's been prescribed by their doctors.

Instead they cover the cost of the medication preferred by insurance companies.

Patients can fail multiple times on medications before gaining access to the drugs originally recommended by their physicians.

"We need to be really careful about putting cost control efforts on the backs of individual consumers, especially the most vulnerable consumers who are most dependent on their access to stable prescription drug therapies that make it possible for them to have good quality of life," said bill co-sponsor Sen. Heather Sanborn, D-Portland.

This bill would not ban step therapy, but rather make the appeals process faster for patients, and give doctors an opportunity to override the insurer in certain cases.

Opponents, however, say step therapy benefits patients.

"Health plans use step therapy to protect patients both from unnecessary and dangerous care and from high health care costs," said Katherine Pelletreau, Executive Director of the Maine Association of Health Plans. "So we oppose this bill on the basis of cost and safety."

They say that trying other similar options can help cut down on costs.

"We believe in working with physicians and with our members to find the best, most affordable and appropriate treatments, not necessarily the top-dollar brand name drug treatment," said Pelletreau.

The bill will be worked on in the coming weeks.