LANSING, Mich., March 19, 2024 — State Rep. Mike McFall (D-Hazel Park) held a press conference today to debut legislation to discuss step therapy reform, as addressed by his House Bill 5339. Step therapy, also called “fail first,” is a practice in which insurance companies require patients to try and fail with cheaper, less effective medications or therapies before allowing them to access their physicians’ originally prescribed treatments. Participants included patients, providers and members of the Michigan State Medical Society.
“Patients should be making medical decisions with the advice of their doctors, not their insurance companies. But too often, insurance providers and pharmacy benefit managers require patients to try and fail with alternative remedies before accessing the treatment doctors initially prescribed. HB 5339 brings critical reforms to the process by ensuring providers, not insurers, drive the process. Patients should be able to access the care they need — the first time,” said McFall.
HB 5339 creates an accessible process for healthcare providers to request a medication exception to avoid the step therapy process. This legislation aligns Michigan with 36 other states in the nation that have already passed laws and taken measures to protect patients from the negative consequences that can accompany step therapy.
“Physicians — not health insurers or other middlemen — know what treatment is best for their patients. Many states across the country have already taken action to address the harmful practice of step therapy and preserve the patient-physician relationship, and it’s time for Michigan to act,” said Kate Dorsey of the Michigan State Medical Society. “Step therapy reform is needed to ensure patients have timely access to necessary medications while also allowing for physicians to determine what treatment best serves the needs of their patients.”
The bill has been referred to the Committee on Insurance and Financial Services.
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