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Gov. Baker signs bill to overhaul an insurance prescription practice

Gov. Charlie Baker on Tuesday signed a bill to restrict the practice in which some patients are made to try and fail on insurance-preferred treatments before their insurer will approve a more expensive option prescribed by a doctor.

"On behalf of the dozens of patient groups who worked so hard on this issue, we are thrilled that Governor Baker has signed it into law," said Marc Hymovitz of the American Cancer Society Cancer Action Network, who led the coalition supporting the bill. "This law puts treatment decisions back in the hands of doctors and patients where it belongs. It ensures patients will get the necessary medicine in a timely manner."

The final votes on the so-called step therapy bill (H 4929) came after the House adopted a Rep. John Lawn amendment (H 5258) addressing the number of days allotted for appeals under the bill. The final bill calls for insurers to process step therapy appeals in three business days or 24 hours in cases involving emergencies.

Sen. John Keenan said the bill will help multiple sclerosis patients by allowing them to stay on treatments that work for them even if their health insurer changes their formulary or if the patient has to change insurance coverage.

"People living with MS need early and ongoing access to the disease-modify therapy that works best for them in order to slow the progression of the disease," Laura Hoch, senior advocacy manager for the National Multiple Sclerosis Society, said in a statement released by Keenan's office. "This legislation will help to ensure that they have continuity of care in their MS treatments and are not forced onto drugs that they know do not work for them."


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