Senate health negotiators focus on step therapy, welfare reform bills

House members want patient protections added to bill aimed at lowering KanCare drug costs

By Megan Hart, April 27, 2016

Headshot of Senate Public Health and Welfare Committee Chair Michael O'Donnell

Sen. Michael O’Donnell, a Wichita Republican and chairman
of the Senate health committee, said during a health
conference committee meeting Wednesday that House
members shouldn’t seek major changes to a step therapy
bill approved by the Senate. (Photo by KHI News Service)

Leadership in the Senate health committee has staked out priorities for whatever remains of the session, but it isn’t clear if the House shares them.

A conference committee made up of members of the Senate Public Health and Welfare and House Health and Human Services committees met Wednesday morning and afternoon to consider some of the 15 bills it was assigned to work.

Two bills received the most time: one that would allow the use of “step therapy” in KanCare, the state’s privatized Medicaid program, and another that would make changes to Kansas public assistance programs.

Step therapy would require KanCare patients to start with a cheaper medication before “stepping up” to a more expensive option.

KanCare patients who already are using a more expensive medication wouldn’t be required to fall back to a cheaper one, said Sen. Jim Denning, an Overland Park Republican who introduced the bill. Denning wasn’t originally named as a member of the conference committee but joined it Wednesday afternoon, ostensibly to advocate for the step therapy bill. 

Sen. Michael O’Donnell, a Wichita Republican and chairman of the Senate health committee, said he was willing to compromise on step therapy but urged House conferees not to insist on major changes to the bill, which passed the Senate but not the House.

“We have a pretty set Senate position,” he said.

The state budget, which already faces a $229 million shortfall in the current fiscal year and the next, includes $10.6 million in anticipated savings from implementing step therapy. That estimate comes from an actuarial study, Denning said.

Rep. Jim Ward, a Wichita Democrat, said he wants protections added to the bill to ensure that people with psychiatric conditions, HIV and certain chronic conditions such as multiple sclerosis receive the specialized drug therapies they need.

Language allowing physicians to bypass the step requirements when they think longs periods of trial and error could endanger a patient also should be added to the bill, Ward said.

“Your individual physician should be able to tell the bureaucrats, ‘This particular case is different,’” he said.

Rep. Dan Hawkins, a Wichita Republican and chair of the House health committee, said he didn’t think the Legislature should exclude specific medical conditions from step therapy but would like to see protections added that mirror those in private insurance plans.

“I’m certainly not prepared to move ahead today with step therapy,” Hawkins said, noting that he was waiting for private insurance companies to provide him with information about the patient protections they utilize.

Hawkins left the door open for a compromise on the bill, however, noting the importance the Senate had placed on it.

“I think it can emerge” from conference committee, he said. “You don’t want to make it so restrictive that it doesn’t work.”

The two sides seemed closer to agreement on a sequel to the HOPE Act, which would add to controversial changes made last year in welfare and food assistance programs.

This year’s bill would lower the lifetime cash assistance limit to 24 months from the current 36 and require all eligible adults in a household receiving food assistance to search for work or complete job training in order to continue receiving their benefits.

It also would require the Kansas Department for Children and Families to guard against welfare fraud by monitoring how often households request new benefit cards and by cross-checking lottery winners and public assistance recipients.

O’Donnell said other states have found evidence of “hundreds of millions of dollars” in public assistance being spent on lottery tickets.

But Ward said the bill is about politics, not cracking down on welfare fraud.

“What it does is denigrate and disrespect people who are struggling, and it’s being done for political purposes, not save money and not to protect the system,” Ward said.

A memorandum written earlier in the session by Senate Majority Leader Terry Bruce, and obtained by the Topeka Capital-Journal, confirms that Republicans see welfare reform as a winning issue.

Hawkins, who introduced the HOPE Act with Sen. Mary Pilcher-Cook, a Republican from Shawnee, earlier this session insisted fraud prevention is the primary purpose of the bill

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.

http://www.khi.org/news/article/senate-health-negotiators-focus-on-step-therapy-welfare-reform-bills#sthash.1ikUFE44.dpuf

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