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Louisiana, South Dakota Curb Step Therapy

Lawmakers in South Dakota and Louisiana didn’t let the coronavirus derail their efforts to protect patients.  Both state legislatures have now passed laws to limit the harmful effects of step therapy. 

Step therapy, a process that requires patients to try and fail on an insurer-preferred medication before gaining access to the one their doctor prescribed, interrupts patients’ plan of care.  But in South Dakota and Louisiana, insurers will soon have new regulations on the practice.

The laws add significant patient protections, including:

  • Consideration of clinical practice guidelines.  Insurers will be required to consult evidence-based and peer-reviewed clinical guidelines when establishing their step therapy policies.  This measure will keep insurers from requiring patients to try approaches that are inappropriate or unproven for their condition.
  • Greater transparency.  Insurers must provide clear pathways so patients and providers know what steps are required and what the timelines are.  
  • Exception procedures.  The laws outline when insurers should allow exceptions to step therapy and what the appropriate timeframes are for insurers responding to exception requests.  The laws say patients should be exempted when they have a documented history of unsuccessfully trying the medication – even if that experience occurred under another insurer – or when the medication could impair patients’ ability to function, could cause mental harm or could be ineffective.

Louisiana’s language even requires that patients’ stability on their current medication be considered as a reason to exempt them from having to try a health plan’s preferred treatment. 

The new laws represent an important step toward protecting patient-centered care for the people of Louisiana and South Dakota.  With fewer insurance hurdles to overcome, patients and health care providers can focus on determining the best course of treatment – and on keeping that treatment accessible once patients have their disease under control.   

Both laws will apply to plans offered as of January 1, 2021.

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