SANTA FE, N.M. – Patients will be able to get the medications they need for serious diseases without having to try another medicine and be forced to “fail first” under a new bill that passed Tuesday that would place reasonable limits on the practice known as “Step Therapy.”
The bill, which was placed on the governor’s call early in the session, will reform the process that forces patients to try drugs that insurance companies choose, making patients “fail first” before the patient gets to use the medicine that their doctor originally prescribed.
The bill, SB 11, places limits on this practice and help get the right medicine to patients faster.
The bill was sponsored by Senators Elizabeth "Liz" Stefanics (D-Cerrillos) and Gay G. Kernan (R-Hobbs) and Representatives Elizabeth "Liz" Thomson (D-Albuquerque), Monica Youngblood (R-Albuquerque).
This is the first New Mexico law to reform the practice of insurance companies requiring a “fail first” procedure before patients can get the prescriptions written by doctors.
Drugs prescribed by doctors and used to combat serious diseases such as cancer, Alzheimer’s, diabetes, epilepsy, or rheumatoid arthritis are routinely denied by insurance companies under Step Therapy and patients are forced to try a less effective drug until it fails before getting approval to use the drug prescribed by the doctor.
The reform of the Step Therapy legislation was backed by numerous groups, including AARP New Mexico, MS Society, Albuquerque Center for Rheumatology, National Psoriasis Foundation, American Academy of Dermatology, American Cancer Society, Arthritis Foundation, Crohn’s & Colitis Foundation, Epilepsy Foundation, March of Dimes, New Mexico Cancer Center, and many more.
New Mexico joins more than a dozen other states that have passed laws to limit or reform Step Therapy, including Texas, New York, Iowa, Indiana, West Virginia, and Connecticut, and many more are considering legislation currently. The new legislation requires insurers to base medication decisions on strict guidelines, allow patients to take the prescribed drug if the clinical characteristics of the insurer’s drug are known to be ineffective, and exempt patients who have already proven to be stable on the prescribed drug.
The legislation needs the governor’s signature to become law.