Legislation Addresses Barriers to Treatments, Would Streamline Access to Needed Care for Thousands Across New Hampshire

Susan G. Komen^® Commends Bill Introduction; Urges Quick Passage

CONCORD - Susan G. Komen®, the world's leading breast cancer organization, applauds Representative David Nagel (R-Belknap) for introducing legislation that would provide protections for all patients facing step therapy and prohibit the use of step therapy for metastatic cancer patients. Studies have shown that as little as a four-week delay in treatment for metastatic cancer is associated with increased mortality.

Step therapy, also referred to as "fail first," requires a patient to first try a health plan preferred drug, have that drug fail them - meaning the treatment didn't work for the patient - before they can use the treatment their provider prescribed. This health plan technique is used in an attempt to control costs; despite evidence showing step therapy protocols often adversely impact a patient's treatment and health outcomes. Although metastatic breast cancer cannot be cured, it can be treated. Treatments are highly personalized and must be based on the decisions between the patient and their health care providers in a timely manner.

"Treatment decisions, especially for diseases like metastatic breast cancer where delays or deviations could be deadly, should never be dictated by arbitrary and outdated insurance protocols." said Molly Guthrie, Vice President of Policy and Advocacy at Komen. "Cancer patients facing aggressive diseases should not be forced to have an alternative treatment fail them rather than receiving the most effective treatments from the beginning,"

HB 1638, introduced by Rep. Nagel, would provide guardrails for all patients that face step therapy protocols and prohibit the use of step therapy for metastatic cancer treatments and the associated conditions caused by the patient's treatment.

"As a physician, I believe in patient-centered care, especially for those dealing with complex medical illness or metastatic cancer. Each patient is unique, and access to health care needs to be patient specific, something that can be constrained by insurance mandated step-therapy protocols. In order to create meaningful reform and improve access to evidence-based care, while controlling cost, I am proud to introduce HB 1638 that will give these patients an appeal process to step-therapy practices to ensure they have timely access to treatment prescribed by their physician without having to fail less effective medications first merely because it's the less costly, but, too often, less effective option," said Rep. Nagel, MD. "This legislation will also help metastatic cancer patients who do not have the time to wait to access effective treatments and help significantly improve their lifespan and quality of life."

Most step therapy protocols rely on generalized information regarding patients and their treatments and don't consider unique experiences, previous responses to treatments and any comorbidities. Additionally, step therapy policies are particularly burdensome in oncology, given the individualized nature of modern cancer treatments. Komen believes treatment decisions are most effectively made through a collaborative process involving patients and their providers, prioritizing individual needs and not based on harmful insurer policies.