MS Activists help to pass step therapy reform and continuity of care in Massachusetts!
November 9, 2022
Over the last decade, Massachusetts MS Activists have worked tirelessly to pass legislation that would provide continuity of care in MS treatments for people living in the Commonwealth. This effort eventually combined with advocacy for step therapy reform. On October 24, the legislature unanimously passed H 4929, legislation addressing both issues, and on November 1, Governor Baker signed it into law.
Step therapy or “fail first” policies are a form of utilization management that health plans use as a mechanism to control the order in which patients take certain therapies. Step therapy protocols require that patients must try one or more medications selected by their insurer before the plan will grant coverage for the drug originally prescribed by the healthcare provider. Step therapy protocols transition medical decisions from a shared decision-making approach between the provider and the patient towards more standardized policies that focus on cost-effective care.
Once H 4929 takes effect, it will reform the step therapy process, allowing for clear exceptions to the process including if a patient has previously failed on the insurer-selected drug or the drug is contraindicated for the patient. The legislation lays out a clear exceptions process so that providers across the Commonwealth can follow the same guidelines. In addition, the bill allows for continuity of care in both providing an exception to the step therapy process if the patient is already stable on a medication and allows for continued access to the medication during the review process for those requesting exceptions.
Since the very first continuity of care bill was introduced over ten years ago, MS Activists have called, emailed, held meetings, demanded hearings, and shared their very real lived experiences of how they have lost access to the disease-modifying therapies (DMTs) on which they were stable. Eventually, activists were able to get continuity of care language into the step therapy reform and advocated for them to be passed as one. Together with staff and the MS community throughout the Commonwealth, they made their voices heard and helped pass this critical piece of legislation.