Committee hears bill to bar step-therapy for metastatic cancer; oncologists and advocates urge prompt access

Supporters of House Bill 2536 told the House Committee on Behavioral Health and Health Care that the bill is designed to prevent insurers from making metastatic cancer patients try and fail on a plan-preferred drug before permitting the provider-prescribed therapy.

Barrett Johnson, staff for Representative Tasia Graber (sponsor), said the measure would prohibit step therapy for advanced metastatic cancer patients and limit coverage to FDA-approved therapies; supporters sought to preserve coverage while ensuring clinicians — not insurers — decide time-critical care. Elena Teer of Susan G. Komen described oncologists’ reports of patients being forced to make repeated clinic visits to receive short-acting drugs rather than a single long-acting dose while waiting for insurer approvals; she said that is burdensome and dangerous for immunocompromised chemotherapy patients, particularly in rural areas.

Travis Mavison of the Hospital Association of Oregon and other provider witnesses supported the bill as a way to remove administrative burdens and delays that can impede treatment in critical moments. Witnesses from insurers, including Tom Holt of the National Association of Benefits and Insurance Professionals (Oregon Chapter) and Dr. Tracey Mude of Regence Blue Cross Blue Shield of Oregon, urged caution. They warned that removing step therapy requirements could accelerate use of high-cost new cancer drugs whose clinical benefit sometimes remains uncertain, particularly drugs approved on the FDA accelerated pathway. Dr. Mude cited studies showing some accelerated approvals were later withdrawn or failed to demonstrate overall survival or quality-of-life improvements, and said payers need utilization tools to manage costs and protect patients from unproven therapies.

Committee members questioned how often step therapy is imposed and whether removing the tool could lead to increased use of expensive, experimental drugs. Witnesses described a spectrum of practice and said utilization review and peer-to-peer review remain available for oversight; advocates proposed limits in the bill to FDA-approved therapies and safeguards to preserve medical necessity review.

Why it matters Metastatic cancer treatment decisions are time-sensitive and complex. Advocates argue that requiring patients to fail on insurer-preferred drugs before receiving provider-recommended therapies can cause clinically meaningful delays in care; payers say prior authorization and step therapy help manage adoption of expensive, sometimes unproven medications. The committee heard personal accounts and technical testimony but did not take a vote at this hearing.