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News & Press: Pain Policy

New Law Protects West Virginians from Unsafe Step Therapy

Friday, April 7, 2017   (0 Comments)
Posted by: Katie Duensing, JD, Asst. Director, SPPAN
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We have great news, West Virginians! With the passage of House Bill 2300, patients and prescribing practitioners are guaranteed access to a clear and convenient process to request a step therapy exception determination made easily accessible on the health plan issuer’s or utilization review organization’s website. Further, and of the utmost importance, the new law requires a step therapy exception to be expeditiously granted if:

  1. The required prescription drug is contraindicated or will likely cause an adverse reaction by or physical or mental harm to the patient.
  2. The required prescription drug is expected to be ineffective based on the known relevant physical or mental characteristics of the patient and the known characteristics of the prescription drug regimen.
  3. The patient has tried the required prescription drug while under their current or a previous health insurance or health benefit plan, or another prescription drug in the same pharmacologic class or with the same mechanism of action and such prescription drug was discontinued due to a lack of efficacy or effectiveness, diminished effect, or an adverse event.
  4. The required prescription drug is not in the best interest of the patient, based upon medical appropriateness.
  5. The patient is stable on a prescription drug selected by their health care provider for the medical condition under consideration.

This law will become effective in West Virginia on June 19, 2017.