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Step-therapy reform bill would add bypass, carve out metastatic cancer, advocates say
Summary
HB 16-38 would create a bypass/appeal pathway for insurer step-therapy (fail-first) protocols and remove step requirements for metastatic cancer patients; patient advocates and medical groups told the committee step therapy can delay or harm care, while carriers and the Insurance Department urged further stakeholder work.
Representative Nagel opened the public hearing on HB 16-38 by saying the bill would create a bypass mechanism for step-therapy when medically necessary and that a work group would be helpful before moving the bill forward.
"What step therapy is for them is more of a rigid thing... it's called a fail first policy," Rep. Nagel explained, adding the aim is not to eliminate step therapy but to ensure clinicians and patients can bypass it when clinical judgment warrants.
Advocates from the…
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