The Kansas Legislature added several patient protection measures to a bill allowing “step therapy” for Medicaid drugs before passing the legislation early Monday morning.
Advocates for Kansans with mental illness and other conditions were pleased with the changes but remain concerned about the possible effects of the underlying bill on vulnerable patients.
Step therapy requires Medicaid patients to try the least expensive medications for treating their ailments first. If those fail, they can then “step up” to a more expensive alternative.
Gov. Sam Brownback’s administration wrote about $10 million in savings into its budget proposal under the assumption the Legislature would sign Medicaid step therapy into law.
The three insurance companies that administer KanCare, the state’s privatized Medicaid program, will decide how to impose the step therapy requirements, with guidance and oversight from the Kansas Department of Health and Environment and a Drug Utilization Review Board that includes doctors, pharmacists and other health care professionals.
Supporters of the bill, like Sen. Michael O’Donnell, a Republican from Wichita who chairs the Senate Health and Human Services Committee, said most commercial insurers use the practice.
But several House members, including Rep. Dan Hawkins, a Republican from Wichita, said those insurers generally only use step therapy for some classes of drugs and include a variety of patient protections.
Negotiations in a conference committee that Hawkins and O’Donnell led produced a revised bill that added some of those protections to the Medicaid plan.
The final bill exempted all medications prescribed before the law takes effect July 1 and placed a 30-day limit on the time patients may be required to use a cheaper multiple sclerosis drug.
It also included provisions allowing physicians to appeal an insurer’s order to try a cheaper medication if:
- The patient is likely to have an adverse reaction to the drug.
- The patient’s individual “clinical characteristics” make the drug unlikely to work.
- The patient previously tried the cheaper drug and it failed or caused an adverse reaction.
- The patient previously was stabilized by a different drug for the same condition.
Sen. Vicki Schmidt, a Republican from Topeka, unsuccessfully offered several similar amendments when the original step therapy proposal came to the Senate floor in February. The bill passed the Senate 23-16 without the protections.
In the ensuing months, a coalition of concerned groups ramped up efforts to convince House members to revise the bill. The coalition included doctors, mental health advocates and representatives from organization dedicated to fighting specific diseases like cancer and multiple sclerosis.
Kari Ann Rinker, a lobbyist for the National Multiple Sclerosis Society, said the group knew the bill was likely to pass because it was in the governor’s budget but wanted to at least add some patient safety parameters.
Rinker said her group would have preferred to see the 30-day limit apply to all conditions, not just multiple sclerosis. As it is, the bill contains no time limit for how long patients must try drugs that fail to give them relief from other conditions, including those that could be a symptom of their multiple sclerosis.
Still, she said the final product matches up better with what other states do in their Medicaid programs than the original bill.
“We are thankful for the work of Rep. Hawkins on this,” Rinker said.
Amy Campbell, a spokeswoman for the Kansas Mental Health Coalition, also praised Hawkins, saying he “stuck to his guns” on adding the patient protection measures.
“This is a much, much better bill than what came out of the Senate,” Campbell said. “Having said that, we did not support it because mental health medications should be exempted from these practices.”
Campbell and other mental health advocates say many patients already struggle to find prescription medications that can control their symptoms without interference from insurers.
She said she was “really unhappily surprised” to hear legislators say during the final debate on the bill that it exempted mental health drugs after she had one-on-one meetings with them to tell them otherwise.
“I don’t know why that rhetoric was brought forward,” Campbell said. “If you read the bill, it was absolutely clear that without the passage of that bill you can’t have step therapy for mental health medications, and with the passage of that bill Medicaid can have step therapy for mental health medications.”
Mental health medications will have to go through an additional advisory committee before they can be added to step therapy protocols.
Campbell and Rinker both said their organizations would continue to advocate for patients as the new step therapy regulations are rolled out.
Schmidt said she was happy to see many of the amendments she offered get written into the bill later, but as a pharmacist she still had concerns about the practicalities of navigating step therapy with three KanCare companies.
“Patient safety and patient well-being I hope is what we’re all concerned about,” Schmidt said. “If this works like it’s projected to work, then great. But I think there will be people watching very closely how it’s implemented.”
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso
