For several years, one of the major priorities of MHANYS has been a bill
that would lessen the impact of step therapy (commonly referred to as ‘Fail
First). There are few things more difficult to witness then when a loved
one struggles with a medication on their existing formulary that is not
working, only to have to wait weeks to titrate off that medication to
another medication that also may not be effective. It is heart wrenching to
witness. There is no cookie cutter way that individuals with mental illness
recover just like there is no cookie cutter way that people get the
appropriate medication that works for them.

What we do know is that individuals do better when they have the
appropriate medication choice in consultation with their doctor. These
sometimes lifesaving medications should not be left to the discretion of a
formulary. The landmark legislation signed by Governor Cuomo on New Year’s
Eve creates an appeals process that dramatically lessens the time that an
individual has to wait to find out if the medication change is approved. It
also provides greater discretion for Doctors.

This legislation does not end the practice of ‘step therapy’ but it creates
consumer protections to help insure the most appropriate medication for an
individual.

We thank Governor Cuomo for signing this bill into law—it is a great
victory for the mental health community and for individuals with many other
illnesses. We very much thank our Senate sponsor, Senator Cathy Young for
her tireless advocacy as well as Assemblyman Matthew Titone, also for his
dedication to this issue.

To have the kind of successful campaign that we had in 2016 take a lot of
grassroots advocates. Many mental health advocates called up the Governor
and sent letters urging his support. Many of the other advocacy groups did
as well including our colleagues at NAMI who have also regarded this issue
as a priority area. The New York State Chapter of The American Cancer
Society presented petitions to the Governor with over 6000 signed names.
Other groups provided strong grassroots efforts as well. There are so many
organization who deserve credit for the passage of the bill. Over two
hundred groups signed on in support. There are so many individuals who
should be acknowledged for their efforts—whether through op-eds, media
interviews or legislative meetings.

One person who deserves a great deal of credit for the success of the
campaign is Marcy Savage of the lobbying firm of Reid, McNally and Savage.
Marcy was the quarterback of the campaign who worked tirelessly to make
sure this legislation was signed into law. Jennifer Daly of Grey Media
Group also deserves a lot of credit for all her work on getting media
support for this important cause. Finally, this legislation would never
have happened without Kathleen Arntsen from the Lupus and Allied Disease
Foundation. Kathleen has been tirelessly dedicated to this issue for many
years. She has used her own personal experience to affect real change. None
of this would have happened without her and those other courageous people
who came forward to share their own individual narratives.

Listed below is an article from Politico talking about the Governor’s
signing of this legislation.

Cuomo Signs Step Therapy Bill, Vetoes Enhanced Safety-net Legislation
By Dan Goldberg

12/31/2016 09:33 PM EDT

Gov. Andrew Cuomo signed a bill Saturday changing the rules surrounding
step therapy, a process by which insurers can require that certain drugs be
tried first before approving a physician’s prescription.

The bill, which passed unanimously in the State Senate and Assembly, does
not ban the use of step therapy but does provide rules governing how physicians
may appeal an insurer’s decision and how long an insurer has to answer that
appeal.

The new law requires insurers to provide an answer to the appeal within 72
hours, or 24 hours in case of emergency.

Physician groups and patient advocates were quick to praise Cuomo.

“We thank Governor Cuomo for seeking to address the concerns regarding step
therapy protocols that had been raised by patients and physicians,” Malcom
Reid, president of the Medical Society of the State of New York, said in a
statement.

“By signing this bill to limit step therapy policies, the Governor is
helping patients get access to the lifesaving medicine they need” Julie
Hart, director of government relations for the American Cancer Society
Action Network, said in a statement.

The bill was opposed by the New York Health Plan Association, a trade group
representing insurers, which worried about vague language in the law that
could let physicians declare their preference is in the “best interest of the
patient” — a subjective term — and override an insurer’s decision.

Cuomo on Saturday also vetoed legislation that would have created a new
definition for safety net hospitals and required the administration to
provide a higher Medicaid rate to those newly designated hospitals.

The bill passed unanimously in both chambers last June. Cuomo’s veto was expected
because the legislation would have required increased Medicaid funding
without specifying how the state would pay for this new obligation or how
much it would cost.

View Cuomo’s veto messages here: politi.co/2iROVmL

 

 

Glenn Liebman, CEO
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