"A PATIENT who is stable on a medication then switches insurance plans can no longer be kicked off that medication by their insurer, under a new law Gov. Charlie Baker signed Tuesday that limits the insurance practice of “step therapy.”Patient advocacy groups have been trying for years to restrict when insurers can use step therapy, or fail-first therapy, in which the insurance company requires a patient to try a less expensive drug before switching to a more expensive one. After years of negotiations between patient advocates and insurance companies over language, a bill was finally passed during informal legislative sessions last month. Baker signed it Tuesday evening over the objections of some in the insurance industry who worried that it would raise costs.“This law puts treatment decisions back in the hands of doctors and patients where it belongs,” said Marc Hymovitz, government relations director in Massachusetts for the American Cancer Society Cancer Action Network, who led the coalition pushing for the bill. “It ensures patients will get the necessary medicine in a timely manner.”While earlier versions of the bill would have effectively banned step therapy, this bill allows it but creates a number of exemptions, circumstances under which insurers cannot require step therapy. It also requires timely rulings on appeals when patients believe they were incorrectly denied coverage for a drug. "
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Direct link to the signed legislation -> https://malegislature.gov/Bills/192/H4929
|CommonWealth Magazine: "Baker signs bill curbing step therapy"|