David Shillcutt, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in HR Dive, in “Illinois Bans Step Therapy, Health Plan Prior Authorization for Emergency Mental Health Care,” by Ryan Golden.
Following is an excerpt:
Dive Brief:
- An Illinois law signed last week prohibits health insurers from requiring “step therapy” — a practice in which physicians are required to treat covered patients with less expensive treatments before moving to more expensive ones — and prohibits requiring prior authorization for certain emergency mental health treatment. …
Dive Insight:
Of the two components highlighted in Illinois’ legislation last week, the state’s ban on step therapy is “a lot more interesting,” according to David Shillcutt, attorney and member of the firm at Epstein Becker Green. While many health systems already do not require prior authorization for emergency mental health admissions, Shillcutt said, Illinois “has been on the leading edge” of state restrictions on utilization management practices like step therapy.
Shillcutt added that patients at times have a choice between drugs that treat similar health conditions and that step therapy has been used as a tool to reduce spending on more expensive drugs that are no more effective than less expensive counterparts. But it is hard to predict the exact consequences of banning the practice as Illinois did, he said.
“I think [Illinois] employers are going to see increasing spending on prescription drug benefits and may want to consider navigators or additional services to help patients evaluate the treatment options,” Shillcutt said.
In a twist, Shillcutt said that health plans affected by the state’s ban on step therapy could turn to prior authorization requirements for certain treatments instead. The law contains additional provisions for covered plans requiring them to disclose to the general public information on prior authorization controls for each drug they cover. …
