Facing opposition from fellow Republicans, House Rules Chairman David Lewis killed his own bill Tuesday that would have banned insurance companies from requiring patients to try cheaper alternative drugs.
Several major insurers require what’s known as “step therapy.” When a doctor prescribes an expensive medication, patients must first try cheaper alternative treatments that target the same ailment. If those drugs don’t work, patients can then receive insurance coverage for the drug their doctor recommends.
Lewis, a Dunn Republican, sought to restrict that practice and empower doctors to order exceptions from the insurance mandates. But the bill drew opposition from the N.C. Chamber, insurance companies and even some Republican legislators. Rep. Jeff Collins of Rocky Mount and Rep. Gary Pendleton of Raleigh both said the bill would increase insurance costs and harm small businesses.
After holding a hearing on the bill in the House Insurance Committee, Lewis said he’s withdrawing the legislation. He says he expected the bill would have passed the committee in an 18-15 vote but would face a “protracted floor fight” in the full House. With the House aiming to adjourn the session within a week or so, Lewis said he’ll instead work on the issue between legislative sessions.
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“I understand that a mandate ... drives up the costs of health care,” Lewis said. “What this bill is trying to do is make sure that a patient gets the medicine they’re prescribed, when they’re prescribed it, without having to jump through multiple hoops.”
Blue Cross Blue Shield has said step therapy helps lower drug costs and about 90 percent of patients in the program stick with the alternative drug. The insurer said its rate payers can expect their costs to increase by 5 to 10 percent if the bill passes.
Gregg Thompson, state director of the National Federation of Independent Business, spoke against the bill Tuesday. “Now is the critical time for holding down health care costs,” he said. “North Carolina has one of the (largest number of) mandates in the nation.”
A number of nonprofit groups have called for the ban on step therapy: Arthritis Foundation, National Multiple Sclerosis Society, National Patient Advocate Foundation, National Psoriasis Foundation and U.S. Pain Foundation. They point to the bill’s provision preventing insurers from requiring patients to use opioids that are prone to abuse. The bill would require insurers to cover opioids that are difficult to crush, snort and inject.