Bill allowing ‘fail first’ policy for Medicaid drugs headed to Senate

Amendment clarifies patients won’t have to retry a drug

By Megan Hart, February 04, 2016

A bill that would allow the state’s Medicaid contractors to require patients to start on the cheapest drugs has been amended to exclude existing prescriptions, but some mental health advocates aren’t satisfied that it provides enough protections.

The Senate Public Health and Welfare Committee voted Thursday to release Senate Bill 341 from committee after amending it.

The bill allows the three managed care organizations that administer the Medicaid program in Kansas known as KanCare to use “step therapy,” meaning patients are required to try the cheapest drug believed to be effective for their conditions before progressing to more expensive medications. Budget Director Shawn Sullivan estimated step therapy would save the state about $10.6 million annually.

Sen. Jim Denning, a Leawood Republican who introduced the bill and testified in favor of it, introduced an amendment that would ensure patients would not have to “step down” if they already are prescribed a more expensive drug.

“It's only for new diagnoses going forward,” he said.

Denning said most private insurers and the state employee plan already use step therapy, so Medicaid patients should be subject to the same requirements.

“Step therapy, it’s part of the health care delivery system in the United States,” he said.

Sen. Laura Kelly, a Topeka Democrat, and Sen. David Haley, a Kansas City Democrat, voted against the bill. Haley said he opposed the bill because of concerns from patients and health care providers who said it would delay delivering effective care.

“I believe the responsible vote is to listen to those who implement care in our state,” he said.

Amy Campbell, with the Kansas Mental Health Coalition, said the amendment was a good first step, but the group still is pushing for an exemption for mental health drugs. When people with severe mental illness have to wait for the drug most likely to help them, it raises the risk they will be hospitalized or jailed or die by suicide, she said.

Erik Harkness, a member of the Kansas Mental Health Coalition board who previously worked as a pharmacist, said he is concerned that step therapy will lead to prescriptions for older mental health drugs that have worrisome side effects. For example, he said, Thorazine is a relatively inexpensive antipsychotic because it has been on the market since the 1950s, but it can cause excessive sleepiness and permanent involuntary movements.

“Once this kind of condition develops, folks have a tendency to never leave home again,” he said. “There’s a reason the pharmaceutical companies were able to bring (new drugs) to market — because they have some advantages.”

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

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