Keeping dermatologists in the driver’s seat with step therapy reform
Moving the needle
By Victoria Houghton, Managing Editor, March 1, 2023
DermWorld breaks down the latest highlights of AADA advocacy activities at the federal and state legislative and regulatory level.
Step therapy protocols interfere with patient care and create unwanted burdens on dermatology practices. Thanks to the AADA’s advocacy efforts over the years, dozens of states have enacted step therapy reform laws. With more than half of the country recognizing the value of a physician’s medical judgment, we continue to work in the best interest of you and your patients.
Due to our ongoing advocacy efforts in 2022, several states enacted step therapy reform legislation, recognizing the value of a physician’s medical judgment:
Advocacy priorities
Learn about the Academy’s advocacy priorities and how to join efforts to protect your practice.
Kentucky
Legislation was passed that updates Kentucky’s existing step therapy law that passed a decade ago. The amendments establish requirements for clinical review criteria and clinical practice guidelines used to establish step therapy protocols. The bill strengthens existing medical exceptions to include exemptions for patients who are stable on their medications or if the drug is contraindicated. Additionally, insurers and pharmacy benefit managers would report to the insurance commissioner the number of step therapy exception requests received, denied, and the reason for the denial, and the type of health care providers, or the medical specialties of such providers that submitted a step therapy exception request.
Massachusetts
Gov. Charlie Baker signed step therapy reform legislation into law that will increase transparency, require health plans to respond to appeals in an expedient manner, and provide an exemption from step therapy protocols based on the physician’s medical judgment.
Pennsylvania
Gov. Tom Wolfe recently signed legislation into law that reforms prior authorization and step therapy by increasing transparency, requiring health plans to respond to appeals in an expedient manner, and provide an exemption from step therapy protocols based on the physician’s medical judgment.
Similarly, we worked with the Oregon Dermatology Society to oppose language in an Oregon Medicaid policy that would have created a closed formulary for adult Medicaid patients — providing broad discretion to the state as to whether a drug has “limited or inadequate evidence of clinical efficacy.” Thanks to our advocacy efforts, this closed formulary language was removed from the proposal.
AAD/A Impact Report
Read more about the Academy’s most recent advocacy wins in the latest Impact Report.
Additional DermWorld Resources
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