Susan G. Komen® Commends Bill Introduction; Urges Quick Passage
AUGUSTA – Susan G. Komen®, the world’s leading breast cancer organization, applauds Representative Kristi Mathieson (D-Kittery) and Senator Denise Tepler (D-Sagadahoc) for introducing legislation that would prohibit the use of step therapy protocols for metastatic cancer patients. Studies have shown that 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 requirements 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 diseases like metastatic breast cancer where delays or deviations could be deadly, should never be dictated by arbitrary insurance protocols.” said Molly Guthrie, Vice President of Policy and Advocacy at Komen. “Cancer patients facing aggressive diseases should not be forced to fail on an alternative treatment before receiving the most effective treatments from the beginning,”
LD 178, introduced by Rep. Mathieson and Sen. Tepler would prohibit the use of step therapy protocols for metastatic cancer treatments and the associated conditions caused by the patient’s treatment.
“When someone faces an incredibly difficult diagnosis of metastatic cancer, they should be focused on their treatments and not their financial burden,” said Representative Kristi Mathieson. “I am proud to sponsor LD 178 and work with Senator Tepler and the tireless advocates for cancer patients across our state.”
“When treating metastatic breast cancer, any delays or deviations could be deadly,” said Senator Tepler. “I’m proud to work with Rep. Mathieson to reduce insurance barriers for metastatic cancer patients so they can receive the consistent and effective treatment they need to fight their disease.”
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.
