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One for the Win Column: ISMS-Supported Step Therapy Reforms Now in Effect!
Posted on: 3/28/2018
steps

If you've ever had to go through an insurer’s step therapy process to get your patients on the right prescription or treatment, here's good news!

Rules are now in place to require that Illinois health insurers maintain a medical exceptions process that mandates step therapy exception review. Step therapy is a cost-control method used by health insurers that forces patients to try cheaper prescriptions or treatment alternatives before a physician’s recommended solution can be considered for coverage.

ISMS fought for these reforms, which will allow a step therapy requirement exception if:

  • The required prescription drug is contraindicated;
  • The patient has tried the required prescription drug while under the patient’s current or previous health insurance or health benefits plan, and the prescriber submits evidence of failure or intolerance; or
  • The patient is stable on a prescription drug selected by their health care provider for the condition under consideration while on a current or previous insurer or plan.

ISMS continues to advocate for insurance reforms that put patients first and reduce administrative hassles for physicians.

Questions about the new protections? Contact ISMS' advocacy team by calling 800-782-4767 ext. 1470, or by  sending an email.  



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