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Victory for MS Activists in Pennsylvania

November 9, 2022

After more than seven years of advocacy by Pennsylvania MS Activists, prior authorization and step therapy reform legislation (SB 225) has passed both the Senate and the House unanimously and has been signed into law by Governor Tom Wolf! 

Once implemented, this legislation will streamline the request process by requiring health plans to respond to prior authorization requests in a timely manner. The new prior authorization and step therapy reform law, now known as Act 146 of 2022, will also require health plans to disclose their prior authorization and step therapy review processes and ensure that patient history, the expertise of the prescribing physician, and prevailing science plays a more significant role in a final determination. Additionally, Act 146 will create a basic framework for step therapy requirements. 

Prior authorization requirements can result in delays or disruptions in treatment by requiring healthcare providers to submit documentation justifying their prescription to insurers. Coverage by the health plan is only assured if and when the prior authorization request is approved. Step therapy is a process utilized by insurance companies that requires patients to try and fail with an alternative medication before they cover the medication that was originally prescribed. 

Act 146 is the most significant piece of healthcare consumer protection legislation enacted in Pennsylvania in more than two decades. This law will improve the quality of access to healthcare for 85% of insured Pennsylvanians including countless residents living with MS.

This law is crucial for Pennsylvanians living with MS by making it easier for patients to access and stay on the most effective treatment, as determined by the patient and their healthcare provider, and not by their health insurance company. 

In the past two years alone, MS Activists have sent nearly 1,000 emails to legislators and the governor expressing the importance of this legislation for Pennsylvanians with MS. Thanks to their advocacy, this law will go into effect on December 3, 2022.

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system. Symptoms range from numbness and tingling to blindness and paralysis, and there is currently no cure for MS. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. An estimated 1 million people live with MS in the United States. Most people with MS are diagnosed between the ages of 20 and 50, and it affects women three times more than men.

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