MONTPELIER, VT—On April 10, advocates from NORD and our Rare Action Network® joined five other local organizations at the Vermont State Capitol to call attention to an important piece of legislation (H.766) that will help residents living with rare diseases by reforming their state’s step therapy protocols.
Step therapy policies, also known as fail first, are used by insurance companies in an attempt to control costs by forcing patients to “fail first” on an alternative medication before accessing the medication originally prescribed by their doctor. This can cause delays to necessary care and can be harmful to patients. Vermont earned an F Grade for its step therapy practices in the most recent edition of NORD’s State Report Card.
“At the National Organization for Rare Disorders, we believe health care decisions are best made by patients working with their doctors,” said Carolyn Sheridan, State Policy Manager, NORD. “The 1-in-10 Americans with a rare disease already spend so much time on their diagnostic odyssey – often going years without answers as to what is causing their symptoms – and then struggle to find the right treatment. Rare disease patients should not have to jump through unnecessary, burdensome, and potentially harmful hoops to get the medicine their provider initially ordered.”
Vermont residents, tell your Senators to pass this bill and help patients in the rare disease community receive the medication they need. Vermont has until May 9 to pass this bill and help rare disease patients, when the state’s 2024 legislative session will end.
H.766 establishes categories of exemptions from step therapy protocols, modifies timelines within which health plans must respond to prior authorization requests, and makes responses to requests for a step therapy protocol exemption subject to the same timelines.
More than half of all 50 states have enacted policies to protect patients and ensure health insurers play by a fair set of rules when requiring patients to follow step therapy or “fail first” requirements. Now it’s Vermont’s turn.
